By using the evidence-based communication strategies depicted in this article, oncology nurses can support the delivery of bad news and maintain communication with their patients and their patients' families in an effective and productive manner.

BackgroundVeterans who access both the Veterans Health Administration (VA) and non-VA health care systems require effective care coordination to avoid adverse health care outcomes. These dual-use Veterans have diverse and complex needs. Gaps in transitions of care between VA and non-VA systems are common. The Advanced Care Coordination (ACC) quality improvement program aims to address these gaps by implementing a comprehensive longitudinal care coordination intervention with a focus on Veterans’ social determinants of health (SDOH) to facilitate Veterans’ transitions of care back to the Eastern Colorado Health Care System (ECHCS) for follow-up care.MethodsThe ACC program is an ongoing quality improvement study that will enroll dual-use Veterans after discharge from non-VA emergency department (EDs), and will provide Veterans with social worker-led longitudinal care coordination addressing SDOH and providing linkage to resources. The ACC social worker will complete biopsychosocial assessments to identify Veteran needs, conduct regular in-person and phone visits, and connect Veterans back to their VA care teams.We will identify non-VA EDs in the Denver, Colorado metro area that will provide the most effective partnership based on location and Veteran need. Veterans will be enrolled into the ACC program when they visit one of our selected non-VA EDs without being hospitalized. We will develop a program database to allow for continuous evaluation. Continuing education and outreach including the development of a resource guide, Veteran Care Cards, and program newsletters will generate program buy-in and bridge communication. We will evaluate our program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, supported by the Practical, Robust Implementation and Sustainability Model, Theoretical Domains Framework, and process mapping.DiscussionThe ACC program will improve care coordination for dual-use Veterans by implementing social-work led longitudinal care coordination addressing Veterans’ SDOH. This intervention will provide an essential service for effective care coordination.

Pro-environmental behaviors (PEBs) are crucial to reducing environmental degradations, and much research has focused on two key psychological antecedents: pro-environmental attitudes and efficacy beliefs. Yet, the evidence of their direct and interactive relationships are mixed. Further, few studies investigate how these key relationships vary across different countries and contexts. Using data from a large international survey ( N = 11,000) in 11 countries, we examine relationships among environmental attitudes, efficacy, and PEBs. Overall environmental attitudes are a strong predictor of PEBs, while efficacy has a small direct and a non-significant moderation effect. Within countries, both direct and moderation relationships involving efficacy are tiny. The relative dominance of environmental attitudes as a predictor raises questions about the unique importance of efficacy in explaining PEBs separate from attitudes (and covariates). The nuanced connections between these variables within individual countries highlight the importance of more diverse global environmental research.

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This study develops a model of direct association of exposure to environmental media content, and indirect association through environmental attitude and environmental efficacy, with proenvironmental behaviors. It also considers secondary media roles of exposure to general news media, and involvement in mediated civic activism. The model and hypotheses are tested through Hayes Process mediation models, using secondary, cross-sectional survey data from 11,000 respondents across 11 countries. The model is well-supported overall and within countries, and the secondary media variables have generally consistent effects within countries. Socio-demographic covariates have varying relationships with environmental attitude, environmental efficacy, and pro-environmental behaviors, overall, and within countries. In line with social cognitive theory, these results suggest that media use related to environmental issues does not have to raise individuals' pro-environmental attitude or efficacy (though it does) to increase engagement in pro-environmental behavior.