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Background Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are becoming essential parts of a learning health system, and using these measures is a promising approach for value-based healthcare. However, evidence regarding healthcare professional and patient organizations’ knowledge, use and perception of PROMs and PREMs is lacking. Objectives The objectives of the study were to: 1- Describe the current knowledge and use of PROMs and PREMs by healthcare professional and patient organizations, 2- Describe the determinants of PROMs and PREMs implementation according to healthcare professional and patient organizations. Methods We conducted an environmental scan using semi-structured interviews with representatives from healthcare professional and patient organizations. Interviews were recorded and live coded based on the Franklin framework. We used inductive and deductive thematic analysis to extract information about the main themes addressed during the interview (awareness of PROMs and PREMs, examples of implementation and use of PROMs and PREMs, tools used, vision for future implementation, barriers and facilitators to implementation and the best way to collect PROMs and PREMs data). Results 63% of healthcare professional organizations ( n  = 19) and 41% of patient organizations ( n  = 9) that were contacted agreed to have a representative interviewed. The representatives from both the healthcare professional and patient organizations acknowledged the importance of assessing patients’ experience and outcomes. However, they considered the implementation of PROMs and PREMs tools to be scarce within their organizations, in clinical practice and in the education system. Patient organizations were worried that overuse of PROMs and PREMs could lead to depersonalization of practice. Barriers to implementing PROMs and PREMs included lack of awareness of tools, resistance to change and lack of motivation to complete or explain the questionnaire. Barriers also included factors such as lack of financial, technological and human resources and issues with integration of data and inconsistency of digital platforms. Conclusions This environmental scan revealed a lack of awareness of tools by healthcare professional and patient organizations’ representatives and limited implementation. Adequate training, technological integration, and demonstration of PROMs and PREMs benefits to foster broader adoption in clinical and organizational settings is dearly needed. Addressing these challenges is essential for enhancing value-based care.

Background Cultural and linguistic minorities are at a higher risk of poorer health, poorer health outcomes, and poorer quality of care, in part due to a lack of access to healthcare services. Inequities in access to healthcare services have been found in several Deaf populations and are associated with poorer physical and mental health outcomes. Objective This review aims to describe the breadth, scope, and nature of the literature on access to healthcare services for Deaf adults. Methods A scoping review was conducted according to Arksey and O'Malley. Ten scientific databases and grey literature were searched for reviews published between 2000 and 2025 in English, French, American Sign Language, and Quebec Sign Language. A chart form was created for extraction. Results were analyzed using narrative synthesis and the Levesque et al. conceptual framework of access to healthcare. Research priorities were identified during a deliberative workshop with members of the Deaf community in Québec, Canada. Results Eighteen reviews were included in this study. All dimensions of the conceptual framework have been explored (approachability, ability to perceive, acceptability, ability to seek, availability and accommodation, ability to reach, affordability, ability to pay, appropriateness, and ability to engage). Our analysis revealed new factors influencing access that need to be considered: cultural competence, communication barriers, sociodemographic characteristics, and technological support. We also identified that the social inclusion of the Deaf impacts multiple dimensions in a cross‐sectional manner. Conclusion The Deaf face barriers to accessing healthcare services at every stage of their pathway. This review has identified several areas of access where further research is needed to address the disparities experienced by Deaf communities. There is an urgent need to involve the Deaf community in shaping the research on their access to healthcare services. Patient or Public Contribution A Deaf patient partner contributed as a co‐researcher to the study design, the conduct of the review, and the interpretation of the data. This collaboration helped to contextualise and interpret the findings of the review.

Background Routine capture of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) is championed as core infrastructure for learning health systems and value-based care. Yet, the guidance on how to implement these measures is scattered. We synthesised evidence on implementation strategies used to introduce and sustain PROMs and PREMs, and examined how these strategies align with common barriers and stages of implementation. Methods We conducted a secondary analysis of an umbrella review (25 reviews; 1086 primary studies, 2014–2023) that catalogued implementation determinants and processes of PROMs and PREMs. Two reviewers independently coded implementation strategies using the 73-item Expert Recommendations for Implementing Change (ERIC) taxonomy. Strategies were temporally mapped to the phases of the Exploration–Preparation–Implementation–Sustainment (EPIS) framework, and onto the barriers identified in the parent review using the CFIR × ERIC matching tool. Results Twenty of 25 reviews reported at least one implementation strategy, yielding 152 instances coded to 43 of 73 ERIC strategies. Pre-implementation strategies (74 instances) focused on local consensus building, readiness and barrier assessments, early IT integration, and front-loaded education and champion preparation. During implementation and sustainment (78 instances), the strategies most often used were audit and feedback, real-time data feedback to clinicians, reminders, facilitation, technical assistance, refresher training, and patient onboarding and prompts. Mapping strategies to key barriers showed reasonable coverage for workflow, staff capability, and organisational fit, but gaps for patient capability, long-term financing, data analytics, and equity. Thirty ERIC strategies were not identified, most relating to policy, financing, or market-shaping. Conclusion Implementing PROMs and PREMs in routine care requires coordinated changes in relationships, workflows, technology, and incentives. This study organises existing evidence into practical tools that health system teams and researchers can use to select, sequence, and resource implementation strategies for PROM and PREM programmes.

Positive patient experience is associated with improved health outcomes and greater adherence to recommended care. Patient-reported experience measures (PREMs) are tools developed to assess these experiences and can be used for multiple purposes, including to inform quality improvement. Patient experience is a complex concept that lacks a standardized definition, with multiple constructs described in the literature. The variety of available PREMs makes it difficult for knowledge users to select those that are valid, reliable, and suitable for their specific practice settings, particularly in primary care. The objective of this scoping review is to identify and describe PREMs developed for the primary care context, the constructs measured and their psychometric properties. Following the JBI methodology and PRISMA-ScR guidelines, we conducted a scoping review of studies presenting the development or the psychometric properties of PREMs for adults in primary care in an original or a synthesis design. We searched databases (MEDLINE, CINAHL, Scopus) for studies between January 2019 and December 2023. Two independent reviewers screened and selected studies. They extracted PREMs constructs, psychometric properties, number of items, time of completion and tool availability. Seven studies, including three synthesis designs, were included in the review. From these papers, 23 PREMs were included for data extraction. Tools focusing exclusively on a single component of patient experience, a specific population, or a narrowly defined context were excluded. The constructs most frequently represented across identified tools included accessibility, relational aspects, and quality of clinical care or services. However, no tool covered all relevant constructs, highlighting the variability in defining patient experience. Tools ranged from 4 to 74 items, with limited reporting on completion time. Only five tools involved patients in their development, potentially limiting their applicability in routine practice. Psychometric properties varied, with most tools demonstrating acceptable validity and reliability. However, inconsistencies in reporting and testing methods were noted. This review highlights the diversity of PREMs validated for primary care and the variability in their constructs and psychometric properties. Improving conceptual clarity and alignment of patient experience constructs across PREMs, while ensuring meaningful patient involvement in tool development, and rigorous psychometric testing are essential to enhance their utility. This study supports the integration of PREMs into primary care quality improvement initiatives, contributing to more patient-centered healthcare delivery.

Value-based healthcare (VBHC) implementation is seen as a priority in many healthcare systems worldwide because it advocates for the best health outcomes that matter to patients at the best cost. Patient-reported outcomes measures (PROMs) and patient-reported experience measures (PREMs) are increasingly used to capture this patient's perspective on their health and their experience of care. Consequently, to promote VBHC, an international emergence of health information systems integrating PROMs and PREMs has developed. The goal of our study was to (1) identify the main existing health information systems integrating PROMs and PREMs and (2) describe how their use supports VBHC and value-based decision-making at meso or macro levels. We conducted a scoping review using the Joanna Briggs Institute (JBI) methodology. We conducted a systematic search across MEDLINE, Embase, CINAHL, PsycINFO, Web of Science and Academic Search Complete databases. We carried out a mixed thematic analysis using deductive (frameworks of Franklin et al. and CIHI) and inductive approaches. We screened 7,497 papers from which the title and abstract of 526 papers were identified as relevant for full-text review. A total of 12 papers were retained for analysis identifying systems from six different countries. We described these systems according to four types of governance strategies. PROMs and PREMs tools were selected according to the population segments chosen. They were collected through paper, phone, and digital technologies. Barriers such as lack of time, administrative burden, reluctance to implementation and facilitators such as identifying champions, integrating patients into the process, efficient communication were described. The real-time reporting of data was an interesting innovation that was developed in several systems. PROMs and PREMs were used for benchmarking, quality improvement, performance evaluation but no concrete example of use were reported. This scoping review identifies international initiatives of health information systems integrating PROMs and PREMs. The mechanisms use to support value-based decision-making with this data at meso and macro levels are yet to be fully described. Nonetheless, these results will enable countries to learn from the approaches of others to improve the development and implementation of similar initiatives to support value-based healthcare decision-making.

IntroductionBefore the pandemic, nurses worldwide faced difficult working conditions, including staff shortages, heavy workloads, and traumatic experiences.1 2 These factors contributed to overwork and chronic fatigue, negatively impacting both the quality of care provided and the health of caregivers.3 Studies conducted before COVID-19 revealed that nurses felt inadequately prepared and lacked the confidence to handle crises.4 The COVID-19 crisis intensified these issues, exposing structural and psychological vulnerabilities.ObjectivesThis study aims to identify the coping strategies nurses employed during the COVID-19 health crisis, analyze their effects on professional trajectories, and propose mechanisms that healthcare institutions can utilize to support nurses’ adaptation in times of health emergencies.MethodsAs part of a mixed-methods study on nurses’ career paths, we conducted semi-structured interviews with 74 nurses categorized into five career trajectories.5 6 Two research assistants conducted each interview (~1.5 hours). We employed journey mapping methodology and analyzed data using a framework approach, integrating inductive and deductive methods.7 8 Lazarus and Folkman’s Transactional Model of Stress and Coping guided our analysis.9–11ResultsSanitary measures shaped available coping strategies, underscoring the value of proactive approaches. Nurses who used problem-solving methods (planning, seeking support, adapting) managed stress more effectively than those relying on avoidance (consumption, denial, disengagement). High-risk area nurses reported elevated stress, while those who shifted roles fared better. Many underutilized employer-provided support resources. Some strategies facilitated crisis management but also introduced new challenges.ConclusionUnderstanding the coping strategies nurses use during the pandemic provides critical insights for strengthening resilience and improving retention. Healthcare institutions must adapt support mechanisms to foster long-term well-being and workforce stability.ReferencesHegney DG, Craigie M, Hemsworth D, et al. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results. J Nurs Manag. May 2014;22(4):506–518.Khamisa N, Peltzer K, Oldenburg B. Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review. Int J Environ Res Public Health. May 31 2013;10(6):2214–2240.Alderson M, Parent-Rocheleau X, Mishara B. Critical review on suicide among nurses. Crisis. Jun 2015;36(2):91–101.Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among nurses: a systematic review of literature. Int Nurs Rev. Mar 2018;65(1):41–53.Fortin M-F, Gagnon J. Fondements et étapes du processus de recherche: méthodes quantitatives et qualitatives. Montréal: Chenelière éducation 2016.Gallagher F, Marceau M. La recherche descriptive interprétative. In: Corbière M, Larivière N, eds. Méthodes qualitatives, quantitatives et mixtes: dans la recherche en sciences humaines, sociales et de la santé. Vol 2e ed: Presses de l’Université du Québec; 2020:5–32.Davies EL, Bulto LN, Walsh A, et al. Reporting and conducting patient journey mapping research in healthcare: a scoping review. J Adv Nurs. Jan 2023;79(1):83–100.Miles MB, Huberman AM, Saldaña J. Qualitative data analysis : a methods sourcebook. Fourth edition ed. Los Angeles: SAGE; 2020.Lazarus R, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 1984.Lazarus RS, Folkman S. Transactional theory and research on emotions and coping. European Journal of Personality 1987;1(3):141–169.Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. Feb 1989;56(2):267–283.

The Food Quality Observatory synthetises the nutritional composition of fifteen processed food categories commonly purchased in Québec (Canada). We assessed how the new Canadian front-of-pack (FoP) labelling regulation of a ‘high in’ symbol, to be implemented as of January 1, 2026, would be potentially reflected in these categories and how simulations of reformulation would impact the presence of the symbol. Nutritional information was obtained by collecting food products available in supermarkets and grocery stores in the province of Québec (2016–2022). Sales data were obtained from company. Fifteen food categories have been selected, and three levels of reformulation were simulated. The nutritional values of 5132 products were merged with sales data. 3941 products were successfully cross-referenced. Sixty percent of all products sold ( 2336/3941) would carry the ‘high in’ symbol reflecting a high content of Na, saturated fat and/or total sugar (39 %, 16 % and 17 %, respectively). For certain food categories, a slight reduction (5–15 %) in Na, saturated fat or total sugar content would allow removing the ‘high in’ symbol in a large number of products. For example, a 5 % reduction of the Na content in sliced breads would allow 22 percentage point (pp) fewer products to display the symbol. This study presents a portrait of processed foods purchased in Québec (Canada) and the distribution of the FOP ‘high in’ symbol. Such a portrait generates important data to monitor the food supply’s nutritional quality, which can ultimately contribute to improving the nutritional quality of processed foods.

In the province of Quebec, Canada, interdisciplinary support groups (ISGs) are mandated to support those who are involved in the clinical, administrative, legal and ethical aspects of medical assistance in dying (MAiD). This article presents the results of a mixed-method, multi-phase study carried out in 2021 on ISGs with the aim to describe current ISG practices, critically analyze them and make recommendations on promising practices for provincial implementation. Semi-structured interviews (42) and focus groups (7) with coordinators of 24 ISGs were used to identify promising practices and confirm their utility with participants. We have distributed the ISGs along what we coined an \"ISG continuum.\" Between teams' accountability (decentralization) and ISGs' assumption of responsibility for MAiD requests (centralization), a middle ground approach, focused on the value of support, should be favored. The structuring of ISGs and their practices is intimately linked to their values. Harmonization of ISGs and their practices, while considering their specific values and contexts, can contribute to the equity and quality of services intended for those who request MAiD and those who support them.

To characterise the nutritional quality of food products targeted to children, we aimed: (1) to determine if the nutritional composition of child-targeted food products is different from those for the general population and (2) to verify differences in the nutrient content of child-targeted food products between three selected food categories. The present study is part of the work conducted by the Food Quality Observatory, created in 2016 in the province of Quebec (Canada). Ready-to-eat (RTE) breakfast cereals (n 331), granola bars (n 310) and yoghurts and dairy desserts (n 380) were the food categories analysed. Nutritional values and all packaging information were obtained by purchasing every product available in supermarkets, grocery stores and specialty grocery stores. Free sugars were manually differentiated from total sugars for each product. Products were classified according to two targeted consumer groups: children or general population. The nutrient profile of RTE breakfast cereals, granola bars and yoghurts and dairy desserts targeted to children differed from that of products intended at the general population. Child-targeted RTE breakfast cereals had the least favourable nutritional composition, with significantly higher content of carbohydrates, total sugars, free sugars and Na compared with breakfast cereals for the general population as well as child-targeted granola bars and yoghurts and dairy desserts. All child-targeted products analysed contained free sugars. The current study supports the relevance to further regulate marketing to children on food product packages to ensure that such marketing is not present on food products with poor nutritional quality.

[This corrects the article DOI: 10.3389/ijph.2024.1607407.].