Family physicians act as gatekeepers of the healthcare system and have an indispensable role in providing holistic care in the primary care system. While previous studies had focused on the geographic maldistribution of family physicians, the current study investigated the distribution of job opportunities for family physicians by analyzing recruitment advertisements posted in medical association journals, as an indirect way to observe the marketplace demand for physicians. We collected all the recruitment advertisements for family physicians in the twelve issues of the Taiwan Medical Journal, the official organ of the Taiwan Medical Association, in 2018. In contrast to 124 new trainees annually, 739 advertisements for family physicians were posted within the entire year. After eliminating repeated advertisements, there were 302 distinct advertisements, of which hospitals accounted for 18.9% (n = 57). The job opportunities at hospitals were offered mainly by regional hospitals (n = 26) and community hospitals (n = 29), but only two by medical centers. Family physicians in Taiwan were in great demand not only by primary care clinics but also by hospitals. The role of family physicians in hospitals is worth further study.

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BackgroundACP with a facilitator is acceptable with HIV+ adolescents, but the influence of facilitator on participant satisfaction with FACE has not been studied.AimExamine the relationship between quality of facilitator’s communication and participant satisfaction ratings.MethodsA total of 48 dyads (HIV+ adolescents and their families), randomly assigned into the FACE intervention in a two-arm RCT, were used for this analysis. Participants completed two questionnaires after each of the three FACE sessions: 13-item Satisfaction Questionnaire (Lyon); 5-item Quality of Participant-Interviewer Communication Scale (QC, Curtis). Higher mean scores indicate higher session satisfaction.ResultsTeens were 54% male; 91% African-American; mean age 18 years (range 14–21). Examined by session, correlation between satisfaction and QC scores varied: for adolescents, correlations were: Session 1 (r = 0.40, p = 0.0050); Session 2 (r = 0.27, p = 0.0659); Session 3 (r = 0.40, p = 0.0050). The corresponding figures for families were: Session 1 (0.39, p = 0.0062); Session 2 (r = 0.34, p = 0.0190); Session 3 (r = 0.48, p = 0.0007). Examined by session, means of seven satisfaction items (range 1–35): for teens, Session 1 (27.1); Session 2 (29.1); Session 3 (29.4). The corresponding figures for families were: Session 1 (29.4); Session 2 (30.8); Session 3 (31.2).DiscussionAdolescents and families agreed that participating in the FACE intervention was satisfactory. The ratings of study satisfaction were significantly correlated with the QC among both adolescents and families, with the exception of session 2 with the adolescents.ConclusionAssessing satisfaction with a family-centred intervention should include quality of participant-facilitator communication, as this may be an important variable predicting satisfaction, independent of intervention effects.

BackgroundAdvance care planning (ACP) should begin from the time of diagnosis.AimTo survey the self-reported needs of adults living with HIV/AIDS for end-of-life care.MethodsA 2-arm, randomised, controlled trial of ACP is being conducted in Washington, DC with adults with HIV/AIDS aged ≥21 years and their surrogates beginning October 2013. N = 111 patient/family dyads. Patients were mean age 51 (range 22–74 years), 54% male, 96% African-American and 42% impoverished. Before randomization, participants completed Lyon Advance Care Planning Survey-Patient and Surrogate Versions, 31-items on a 5-point Likert-scale. Prevalence-adjusted bias-adjusted Kappas (PABAK) were calculated.ResultsAt baseline, there was almost perfect agreement (PABAK 0.81–0.99) about the importance of: Understanding treatment choices (98%); being physically comfortable (94%); Being able to complete an advance directive (91%). Slight agreement (Kappa = 0.16) for Being off machines that extend life (49%); fair agreement (Kappa = 0.52) on dying a natural death. Patients preferred to discuss ACP while healthy, 67%. Agreement about best time to “bring up end of life” was slight, to less than chance (30% before getting sick; 1% when first diagnosed; 0% when first sick, first hospitalised, if dying).DiscussionImportant areas of agreement existed without an ACP intervention. However, only slight agreement existed for withdrawing treatment and when to initiate ACP conversations.ConclusionPoor, minority, HIV positive patients are willing to engage in advance care planning with surrogates. Routine, standardised interventions may provide the optimal setting for facilitating conversations about dying a natural death or being on machines that extend life.

BackgroundAdvance care planning (ACP) may decrease decisional conflict and better prepare patients for future healthcare decisions.AimExamine effects of an ACP intervention on decisional conflict.MethodsData were collected from 94 HIV positive adolescents in the FAmily-Centred (FACE) ACP trial from five hospital-based clinics. Participants were randomised to FACE (n = 47) or Healthy Living Control (HLC) (n = 47), each consisting of three 60 min sessions. Participants completed the Decisional Conflict Scale (DCS) immediately following intervention (Time 1) and 3 months post-intervention (Time 2). DCS yields Total and five subscale scores (Means ≥2.5 indicates high decisional conflict; range 1–5). Generalised Estimating Equations (GEE) examined intervention effects controlling for age, gender, and race.ResultsAdolescents were: mean age 18 years (range 14–20); 47% female; 93% African-American. Total decisional conflict and subscales scores were not significantly different between groups regardless of time; nor did scores change significantly over time (Means: Time 1 FACE 1.95 vs. HLC 1.92; Time 2 FACE 2.11 vs. HLC 1.93). African-Americans had higher Total score and Unsupported score vs. non-African-Americans, regardless of time [(Total: slope = 0.2517, p = 0.0075; Means: Time 1 1.94 vs. 1.80, Time 2 2.04 vs. 1.70); (Unsupported: slope = 0. 7502, p = <0.0001; Means: Time 1 2.20 vs. 1.38, Time 2 2.31 vs. 1.74)]. Males had higher Uninformed score vs. females, regardless of time (Uninformed: slope = 0.3094, p = 0.0126; Means: Time 1 1.89 vs. 1.43, Time 2 1.81 vs. 1.68).Discussion/conclusionResults differ from previous ACP studies. Decisional conflict was low overall with no significant intervention effect; rather, demographic variables were more influential.