Strong physician–patient relationships are essential for effective chronic disease management in family medicine. However, the lack of a validated Turkish instrument limits the evaluation of these relationships from the patient’s perspective in primary care. Adapting the Chronic Conditions Physician–Patient Relationship Scale (CC-PPR) into Turkish is therefore necessary to support patient-centered care, assess communication quality, and strengthen research and quality improvement efforts in family medicine practice.This study aimed to adapt the Chronic Conditions Physician–Patient Relationship Scale (CC-PPR) into Turkish and to examine its validity and reliability among patients with chronic diseases receiving care from family physicians.A methodological study was conducted with 254 adult patients attending the Family Medicine Centers between May 01, 2025, and October 01, 2025. The adaptation process followed World Health Organization guidelines. Construct validity was examined using confirmatory factor analysis (CFA), and reliability was assessed through internal consistency (Cronbach’s α, McDonald’s ω) and item–total correlations. Group comparisons were performed across sociodemographic and healthcare-related variables.The CFA supported the original one-factor, 22-item structure with an excellent model fit (χ²[209] = 59.847, p = 1.000; CFI = 1.000; TLI = 1.016; RMSEA = 0.000; SRMR = 0.048). Sampling adequacy was superb (KMO = 0.970; Bartlett’s χ²[231] = 5934.429, p < 0.001). All standardized factor loadings were high (0.63–0.81, p < 0.001). Internal consistency was excellent (Cronbach’s α = 0.977; McDonald’s ω = 0.976), and corrected item–total correlations ranged from 0.74 to 0.86. Marital status, employment status, and type of health institution were significantly associated with relationship scores (p < 0.05).It can be used to assess communication and relational competencies of family physicians, support patient-centered care initiatives, and guide interventions aimed at improving continuity and satisfaction in chronic disease management.The Turkish version of the CC-PPR can be used to assess communication and relational competencies of family physicians, support patient-centered care initiatives, and guide interventions aimed at improving continuity and satisfaction in chronic disease management.

Delivering bad news to a patient is difficult for any doctor. A patient’s reception of such news generally evolves over time and is influenced by various factors.The main objective of this study is to describe the consequences of announcing a cancer diagnosis for the doctor-patient relationship, from the patient’s perspectiveThis is a qualitative study based on semi-structured individual interviews conducted with adult patients suffering from cancer that has stabilized or is in remission. Verbatim extracts from the interviews were analyzed using inductive thematic analysis.Fifteen patients were interviewed between April 2024 and January 2025. The study’s findings indicate that the doctor-patient relationship is a continuum in the patient's life and is built up over the course of life events, including cancer. Cancer has varying consequences on the doctor-patient relationship, whether positive or negative. This unique relationship is put to the test by the expectations, demands and emotions of the cancer patient, who the doctor must accomodate.The announcement of a cancer diagnosis is difficult for the patient but constitutes only one moment within a continuum of announcements. During the oncological journey, the specialist acts as the technical advisor, while the general practitioner acts as a more humain point of contact. He or she is available, depending on the patient's needs, to support them, coordinate their care and monitor their case remotely. Finally, cancer can lead patients to change their lifestyle and pay more attention to their health.For the patient, there is a “before” and an “after” the announcement of a cancer diagnosis, but also for the doctor-patient relationship. This relationship evolves throughout the patient's life, with cancer being a defining moment. However, the patient can count on the general practitioner who was, is and will be there after their cancer diagnosis.For the patient, there is a “before” and an “after” the announcement of a cancer diagnosis, but also for the doctor-patient relationship. This relationship evolves throughout the patient's life, with cancer being a defining moment. However, the patient can count on the general practitioner who was, is and will be there after their cancer diagnosis.

Shared Decision Making (SDM) is a cornerstone of patient-centered care. While established globally, SDM implementation in Korean primary care is hindered by a volume-based reimbursement system and short consultation timesTo analyze barriers to SDM in the Korean clinical context and propose practical strategies for its establishment, focusing on the pivotal role of family medicine specialists.We conducted a comparative analysis of SDM policies and clinical models in the US, UK, Germany, and Canada. We evaluated these against the Korean primary care environment, specifically examining legal frameworks, reimbursement systems, and the continuity of care provided by family medicine specialists.Key barriers identified include the lack of financial incentives and standardized decision aids. We propose three strategic pillars: 1) Clinical Tools: Adopting the "Three Talk Model" and developing standardized Patient Decision Aids (PDAs). 2) Policy Reform: Introducing a specific "SDM Counseling Fee" within the National Health Insurance to compensate for extended consultations. 3) Education: Mandating SDM training in family medicine residency and continuing medical education (CME).Family medicine specialists are uniquely positioned to lead SDM due to their comprehensive and continuous patient relationships. However, sustainable implementation requires shifting from individual effort to structural support through policy and reimbursement reforms.Establishing SDM in Korea requires a multi-faceted approach involving tool development, policy reform, and education. These strategies will enhance patient autonomy and align Korean primary care with global standards of humanistic medicine.

Our national urinary tract infection guideline recommends shared decision making (SDM) for otherwise healthy, non-pregnant women presenting with cystitis. Three options should be discussed: immediate antibiotics, delayed antibiotic prescribing, or ‘watchful waiting’. In practice, this guideline recommendation is rarely implemented.  GP practice staff report particular challenges when applying SDM in women with limited health literacy (LHL).As SDM improves patient involvement, understanding, and personalized care, we aim to explore factors influencing SDM implementation for women with and without LHL presenting with suspected cystitis in general practice.We conducted a qualitative study with three focus groups, two with GP practice staff and one with women with LHL and difficulty with reading and writing. Topic lists were based on the Consolidated Framework for Implementation Research (CFIR). Transcripts were analysed using reflective thematic and framework analysis.Preliminary analyses indicate that GPs and GP assistants often conceptualized SDM as achieving patient agreement to avoid antibiotics rather than facilitating informed choice. Women with LHL described needing clearer explanations of cystitis and treatment options. While all groups valued the patient-healthcare provider relationship, trust between GP assistants and women with LHL appeared fragile. Key barriers included organisational constraints, lack of accessible patient information, safety concerns, and anticipated patient expectations for antibiotics.These findings inform development of an implementation strategy, co-created with GPs, GP assistants and women with and without LHL to enhance SDM for all women presenting with suspected cystitis.Meaningful SDM implementation requires reframing it as facilitating informed choice rather than achieving treatment outcomes, strengthening trust with women with LHL, and creating accessible information within workable practice structures.

Relational continuity of care (RCC), which is characterised by an ongoing therapeutic relationship between patients and their primary care providers, is critical for ensuring high-quality care in general practice. Despite its importance, challenges such as staffing shortages, policy shifts, and evolving patient needs often impede its consistent delivery (1, 2). A number of strategies have been implemented to improve relational continuity, but there is a limited understanding of how these strategies work, for whom, and in which contexts they are most effective  (3)This realist review aims to investigate how, why, and under what circumstances relational continuity of care (RCC) is achieved in general practice, and to explore the outcomes it produces for patients, healthcare providers and the wider healthcare system.A realist review is a theory-driven method of evidence synthesis that incorporates qualitative, quantitative, mixed-methods research, and grey literature. This review will focus on the UK and countries with similar primary care systems, featuring multidisciplinary teams, general practice leadership, group practices, and autonomy over practice organization with defined patient lists. It will use Pawson’s five steps for realist reviews to examine the contexts, mechanisms, and outcomes (CMOs) of delivering RCC in general practice: (1) identifying theories, (2) gathering evidence, (3) selecting articles, (4) extracting data, and (5) synthesizing findings. The review will adhere to RAMESES quality standards for realist synthesis.We will present the final programme theory and results of literature searches as well as stakeholder consensus, which is still underway but will be completed by the spring on 2026..Ultimately, the review will conclude with recommendations for practice and policy, offering actionable insights on how to design, implement, and adapt RCC interventions to improve relational continuity in general practice. The refined programme theory will guide these recommendations, and it will be shared with healthcare practitioners, policymakers, and researchers to enhance the sustainability and effectiveness of RCC interventions in primary care.The findings will provide data to inform future research and refine strategies and policies that support the effective delivery of relational continuity, which in turn may lead to improved patient outcomes and enhanced care experiences.

Taiwan has entered a super-aged society with growing needs for end-of-life and chronic care. Although Taiwan ranks among the highest worldwide in hospice quality, cultural barriers remain. In a family-centered society shaped by Confucian values, older patients often avoid discussing death, and families may resist advance decisions (AD) or advance care planning (ACP), fearing it signals abandonment. Some patients misunderstand the Patient Right to Autonomy Act (PRAA), believing an AD means refusing all life-sustaining treatment. These encounters highlight the gap between legal protection and cultural perception in primary care.This reflection is based on ACP discussions introduced during chronic disease management. Family physicians used familiar language, simple metaphors, and real-life examples to explain the PRAA and correct misconceptions. Instead of starting with documents, physicians first built trust and gradually shifted from disease-focused conversations to discussions about values, goals, and preferences for future care. Longitudinal relationships made these conversations more open and meaningful. Physicians also strengthened their legal literacy through workshops and self-study to better guide patients and families.Legal rights alone cannot ensure meaningful ACP conversations. Trust, continuity, and culturally respectful dialogue are essential. Earlier ACP integration, enhanced clinician training on the PRAA, and community education may help families make value-based decisions. These lessons can inform future training and guide health systems facing similar cultural challenges.Promoting autonomy in East Asian contexts requires empathy, patience, and cultural awareness. Family physicians, who accompany patients across life stages, are well positioned to balance family values with individual wishes. These encounters reveal tension between filial expectations and self-determination. When grounded in patient-centered dialogue, ACP becomes not a refusal of care but a shared process of understanding within families.Integrating ethical reflection, cultural sensitivity, and legal knowledge into family medicine strengthens decision-making and humanistic care. By bridging law and humanity, family physicians help patients and families navigate choices with dignity and mutual respect.