{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:50Z","timestamp":1792787270333,"version":"4.5.0"},"reference-count":62,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Hubei Provincial Natural Science Foundation and Traditional Chinese Medicine Innovation and Development Joint Fund","award":["2023AFD160"],"award-info":[{"award-number":["2023AFD160"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,5,21]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to explore the psychological distress course of Chinese amyotrophic lateral sclerosis (ALS) patients after the onset of the disease and to provide targeted nursing guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>The interview content was analysed qualitatively. We used seven steps of Colaizzi\u2019s method to analyse the participants\u2019 data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Wuhan, China, Traditional Chinese Medicine Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A semistructured face-to-face interview were performed among 22 people with ALS from the motor neuron disease rehabilitation centre of a tertiary Chinese medicine hospital in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>This study included a total of 22 participants, from whom three main themes regarding the psychological distress trajectory of ALS patients were extracted from the interview data: \u2018Time begins to run out\u2019 include tormented and restless waiting and shock and doubt in ALS disease confirmation, \u2018Family out of control\u2019 include the burden of stigma and function loss, the burden of missing family roles, the burden of marriage\u2019s emotional needs and the burden of offspring health, \u2018Way forward\u2019 include struggle between live and death and struggle between quality of life and the value of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study outlines the psychologically distressing journey of ALS patients. Studies have pointed out the need for targeted care to address patients\u2019 various sources of psychological distress to improve their quality of life and coping ability, increase their psychological resilience and reconstruct their life beliefs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082398","type":"journal-article","created":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T06:10:39Z","timestamp":1717827039000},"page":"e082398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Exploring amyotrophic lateral sclerosis patients\u2019 experiences of psychological distress during the disease course in China: a qualitative study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7020-3598","authenticated-orcid":false,"given":"Yiqing","family":"Yu","sequence":"first","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Zeng","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9635-2913","authenticated-orcid":false,"given":"Man","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyang","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufei","family":"Qiu","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Nursing, Hubei University of Chinese Medicine, Wuhan, China"},{"name":"Hubei Shizhen Laboratory, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Xia","sequence":"additional","affiliation":[{"name":"Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China"},{"name":"Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Wuhan, Hubei, China"},{"name":"Hubei Academy of Traditional Chinese Medicine, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,8]]},"reference":[{"key":"2025120519312124000_14.6.e082398.1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410220308"},{"key":"2025120519312124000_14.6.e082398.2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.49.6.1621"},{"key":"2025120519312124000_14.6.e082398.3","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/brain\/118.3.707","article-title":"Natural history of Amyotrophic lateral sclerosis in a database population. validation of a scoring system and a model for survival prediction","volume":"118 (Pt 3)","author":"Haverkamp","year":"1995","journal-title":"Brain"},{"key":"2025120519312124000_14.6.e082398.4","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1159\/000531238","article-title":"Amyotrophic lateral sclerosis (ALS) in southwestern and Eastern Finland","volume":"57","author":"Hanhisuanto","year":"2023","journal-title":"Neuroepidemiology"},{"key":"2025120519312124000_14.6.e082398.5","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.2378","article-title":"Prevalence of Amyotrophic lateral sclerosis in Latium region, Italy","volume":"11","author":"Puopolo","year":"2021","journal-title":"Brain Behav"},{"key":"2025120519312124000_14.6.e082398.6","doi-asserted-by":"crossref","first-page":"946353","DOI":"10.3389\/fnagi.2022.946353","article-title":"Amyotrophic lateral sclerosis in seven provinces of Chinese mainland: a cross-sectional survey from 2015 to 2016","volume":"14","author":"Zhang","year":"2022","journal-title":"Front Aging Neurosci"},{"key":"2025120519312124000_14.6.e082398.7","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322317"},{"key":"2025120519312124000_14.6.e082398.8","doi-asserted-by":"crossref","first-page":"3315","DOI":"10.3390\/cimb45040217","article-title":"Role of oxidative stress on the etiology and pathophysiology of Amyotrophic lateral sclerosis (ALS) and its relation with the Enteric nervous system","volume":"45","author":"L\u00f3pez-Pingarr\u00f3n","year":"2023","journal-title":"Curr Issues Mol Biol"},{"key":"2025120519312124000_14.6.e082398.9","doi-asserted-by":"crossref","unstructured":"An R , Wu Y , Li Y , et al . Pain-related factors and their impact on quality of life in Chinese patients with Amyotrophic lateral sclerosis. Front Neurosci 2022;16. doi:10.3389\/fnins.2022.897598","DOI":"10.3389\/fnins.2022.897598"},{"key":"2025120519312124000_14.6.e082398.10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/21678421.2023.2263868","article-title":"Non-motor symptoms in Amyotrophic lateral sclerosis","volume":"25","author":"Shojaie","year":"2024","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2025120519312124000_14.6.e082398.11","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s10072-023-07119-7","article-title":"Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: a systematic review and meta-analysis","volume":"45","author":"Hamad","year":"2024","journal-title":"Neurol Sci"},{"key":"2025120519312124000_14.6.e082398.12","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jns.2018.12.035","article-title":"Disease progression impacts health-related quality of life in Amyotrophic lateral sclerosis","volume":"397","author":"Prell","year":"2019","journal-title":"J Neurol Sci"},{"key":"2025120519312124000_14.6.e082398.13","first-page":"414","article-title":"Emotional feeling in patients suffering from Amyotrophic lateral sclerosis","volume":"16","author":"Unglik","year":"2018","journal-title":"Geriatr Psychol Neuropsychiatr Vieil"},{"key":"2025120519312124000_14.6.e082398.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2007.11.012"},{"key":"2025120519312124000_14.6.e082398.15","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000167187.14501.0c"},{"key":"2025120519312124000_14.6.e082398.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2007.01843.x"},{"key":"2025120519312124000_14.6.e082398.17","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1994.00540130027010"},{"key":"2025120519312124000_14.6.e082398.18","doi-asserted-by":"crossref","unstructured":"Paganoni S , McDonnell E , Schoenfeld D , et al . Functional decline is associated with hopelessness in Amyotrophic lateral sclerosis (ALS). J Neurol Neurophysiol 2017;8. doi:10.4172\/2155-9562.1000423","DOI":"10.4172\/2155-9562.1000423"},{"key":"2025120519312124000_14.6.e082398.19","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3109\/21678421.2016.1143512","article-title":"I hate being a burden\": the patient perspective on carer burden in Amyotrophic lateral sclerosis","volume":"17","author":"Foley","year":"2016","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2025120519312124000_14.6.e082398.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13024-023-00619-2","article-title":"Opinion: more Mouse models and more translation needed for ALS","volume":"18","author":"Fisher","year":"2023","journal-title":"Mol Neurodegener"},{"key":"2025120519312124000_14.6.e082398.21","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1111\/jocn.15697","article-title":"The illness experience for people with Amyotrophic lateral sclerosis: a qualitative study","volume":"30","author":"Yuan","year":"2021","journal-title":"J Clin Nurs"},{"key":"2025120519312124000_14.6.e082398.22","article-title":"Quality of life of Amyotrophic lateral sclerosis patients in Iran","volume":"37","author":"Fathi","year":"2023","journal-title":"Med J Islam Repub Iran"},{"key":"2025120519312124000_14.6.e082398.23","doi-asserted-by":"crossref","first-page":"4239","DOI":"10.1007\/s10072-022-05930-2","article-title":"Psychoeducational groups for people with Amyotrophic lateral sclerosis and their Caregiver: a qualitative study","volume":"43","author":"Bilenchi","year":"2022","journal-title":"Neurol Sci"},{"key":"2025120519312124000_14.6.e082398.24","doi-asserted-by":"crossref","first-page":"5139","DOI":"10.1002\/nop2.1749","article-title":"The experiences of patients with Amyotrophic lateral sclerosis of their decision-making processes to invasive home mechanical ventilation-A qualitative study","volume":"10","author":"Thorborg","year":"2023","journal-title":"Nurs Open"},{"key":"2025120519312124000_14.6.e082398.25","doi-asserted-by":"crossref","DOI":"10.1186\/s40359-022-00780-1","article-title":"Parental and child adjustment to Amyotrophic lateral sclerosis: transformations, struggles and needs","volume":"10","author":"Sommers-Spijkerman","year":"2022","journal-title":"BMC Psychol"},{"key":"2025120519312124000_14.6.e082398.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-064254","article-title":"Care, burden and self-described positive aspects of caring in Amyotrophic lateral sclerosis: an exploratory, longitudinal, mixed-methods study","volume":"13","author":"Conroy","year":"2023","journal-title":"BMJ Open"},{"key":"2025120519312124000_14.6.e082398.27","doi-asserted-by":"crossref","unstructured":"Kennedy P , Conroy \u00c9 , Heverin M , et al . Burden and benefit-A mixed methods study of informal Amyotrophic lateral sclerosis Caregivers in Ireland and the Netherlands. Int J Geriatr Psychiatry 2022;37. doi:10.1002\/gps.5704","DOI":"10.1002\/gps.5704"},{"key":"2025120519312124000_14.6.e082398.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-060451","article-title":"Advance care planning in Amyotrophic lateral sclerosis (ALS): study protocol for a qualitative longitudinal study with persons with ALS and their family Carers","volume":"12","author":"Vandenbogaerde","year":"2022","journal-title":"BMJ Open"},{"key":"2025120519312124000_14.6.e082398.29","doi-asserted-by":"crossref","unstructured":"Olesen LK , la Cour K , With H , et al . A cross-sectional evaluation of acceptability of an online palliative rehabilitation program for family Caregivers of people with Amyotrophic lateral sclerosis and cognitive and behavioral impairments. BMC Health Serv Res 2022;22. doi:10.1186\/s12913-022-07986-4","DOI":"10.1186\/s12913-022-07986-4"},{"key":"2025120519312124000_14.6.e082398.30","doi-asserted-by":"crossref","unstructured":"Paynter C , Mathers S , Gregory H , et al . Using the concept of health literacy to understand how people living with motor Neurone disease and Carers engage in Healthcare: A longitudinal qualitative study. Healthcare (Basel) 2022;10. doi:10.3390\/healthcare10081371","DOI":"10.3390\/healthcare10081371"},{"key":"2025120519312124000_14.6.e082398.31","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025120519312124000_14.6.e082398.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2020.04.005"},{"key":"2025120519312124000_14.6.e082398.33","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1177\/01939459211030335","article-title":"Computer-assisted qualitative data analysis software, Phenomenology, and Colaizzi\u2019s method","volume":"44","author":"Vignato","year":"2022","journal-title":"West J Nurs Res"},{"key":"2025120519312124000_14.6.e082398.34","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311410900"},{"key":"2025120519312124000_14.6.e082398.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04588.x"},{"key":"2025120519312124000_14.6.e082398.36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2524.2005.00530.x"},{"key":"2025120519312124000_14.6.e082398.37","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/bjhp.12476","article-title":"Does a lack of social support and perceived stigma influence the relationship between motor Neurone disease-related stress and psychological distress","volume":"26","author":"Leigh","year":"2021","journal-title":"Br J Health Psychol"},{"key":"2025120519312124000_14.6.e082398.38","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3233\/TAD-190227","article-title":"Experiences with Assistive technologies and devices (ATD) in patients with Amyotrophic lateral sclerosis (ALS) and their caregivers[J]","volume":"31","author":"Eicher","year":"2019","journal-title":"TAD"},{"key":"2025120519312124000_14.6.e082398.39","doi-asserted-by":"crossref","unstructured":"Soundy A , Condon N . Patients experiences of maintaining mental well-being and hope within motor neuron disease: a thematic synthesis. Front Psychol 2015;6. doi:10.3389\/fpsyg.2015.00606","DOI":"10.3389\/fpsyg.2015.00606"},{"key":"2025120519312124000_14.6.e082398.40","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1080\/21678421.2018.1508477","article-title":"Risk factors for social withdrawal in Amyotrophic lateral sclerosis\/motor Neurone disease","volume":"19","author":"Schl\u00fcter","year":"2018","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2025120519312124000_14.6.e082398.41","unstructured":"Yee WCC , Raymond KC , Clayton N . Hacking stigma by loving yourself: a mediated-moderation model of self-compassion and Stigma[J]. Mindfulness 2018;1\u201319."},{"key":"2025120519312124000_14.6.e082398.42","doi-asserted-by":"crossref","unstructured":"An R , Li C , Li X , et al . Fatigue in Chinese patients with Amyotrophic lateral sclerosis: associated factors and impact on quality of life. Front Neurol 2022;13. doi:10.3389\/fneur.2022.806577","DOI":"10.3389\/fneur.2022.806577"},{"key":"2025120519312124000_14.6.e082398.43","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/17482960802163721","article-title":"Quality of life in Amyotrophic lateral sclerosis\/motor neuron disease: a structured review","volume":"10","author":"Epton","year":"2009","journal-title":"Amyotroph Lateral Scler"},{"key":"2025120519312124000_14.6.e082398.44","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1017\/cjn.2020.240","article-title":"Ransitions in Amyotrophic lateral sclerosis: patient and caregiver experiences","volume":"48","author":"Munan","year":"2021","journal-title":"Can J Neurol Sci"},{"key":"2025120519312124000_14.6.e082398.45","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-066402","article-title":"Analysing the influencing factors on caregivers' burden among Amyotrophic lateral sclerosis patients in China: a cross-sectional study based on data mining","volume":"12","author":"Lian","year":"2022","journal-title":"BMJ Open"},{"key":"2025120519312124000_14.6.e082398.46","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1080\/09638288.2018.1429499","article-title":"Understanding my ALS\". experiences and reflections of persons with Amyotrophic lateral sclerosis and relatives on participation in peer group rehabilitation","volume":"41","author":"Madsen","year":"2019","journal-title":"Disabil Rehabil"},{"key":"2025120519312124000_14.6.e082398.47","first-page":"46","article-title":"Home visit rehabilitation for a patient with ALS to improve social participation","volume":"46","author":"Hakuno A,","year":"2019","journal-title":"Gan To Kagaku Ryoho"},{"key":"2025120519312124000_14.6.e082398.48","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1080\/21678421.2022.2126322","article-title":"The quality of life and depression in primary caregivers of patients with Amyotrophic lateral sclerosis is affected by patient-related and culture-specific conditions","volume":"24","author":"Maksymowicz-\u015aliwi\u0144ska","year":"2023","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2025120519312124000_14.6.e082398.49","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1080\/21678421.2021.1953075","article-title":"Mortality among family members of patients with Amyotrophic lateral sclerosis - a Swedish register-based study","volume":"23","author":"Kl\u00e4ppe","year":"2022","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2025120519312124000_14.6.e082398.50","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1001\/jamaneurol.2019.2044","article-title":"Lifetime risk and Heritability of Amyotrophic lateral sclerosis","volume":"76","author":"Ryan","year":"2019","journal-title":"JAMA Neurol"},{"key":"2025120519312124000_14.6.e082398.51","doi-asserted-by":"crossref","unstructured":"Ozyurt T , Gautam M . Differential epigenetic signature of Corticospinal motor neurons in ALS. Brain Sci 2021;11. doi:10.3390\/brainsci11060754","DOI":"10.3390\/brainsci11060754"},{"key":"2025120519312124000_14.6.e082398.52","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1027\/1192-5604\/a000004","article-title":"Sultan S.On being a child of an ill parent: A Rorschach investigation of adaptation to parental cancer compared to other Illnesses[J].Rorschachiana","volume":"31","author":"Flahault","year":"2010","journal-title":"Journal of the International Society for the Rorschach"},{"key":"2025120519312124000_14.6.e082398.53","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-010-0074-z"},{"key":"2025120519312124000_14.6.e082398.54","doi-asserted-by":"publisher","DOI":"10.1080\/019261802753455651"},{"key":"2025120519312124000_14.6.e082398.55","doi-asserted-by":"publisher","DOI":"10.1037\/0893-3200.19.3.404"},{"key":"2025120519312124000_14.6.e082398.56","doi-asserted-by":"publisher","DOI":"10.1002\/pon.902"},{"key":"2025120519312124000_14.6.e082398.57","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.12071"},{"key":"2025120519312124000_14.6.e082398.58","doi-asserted-by":"crossref","unstructured":"Matuz T , Birbaumer N , Hautzinger M , et al . Sychosocial adjustment to ALS: a longitudinal study. Front Psychol 2015;6. doi:10.3389\/fpsyg.2015.01197","DOI":"10.3389\/fpsyg.2015.01197"},{"key":"2025120519312124000_14.6.e082398.59","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.12557"},{"key":"2025120519312124000_14.6.e082398.60","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13246"},{"key":"2025120519312124000_14.6.e082398.61","doi-asserted-by":"crossref","unstructured":"Rai SS , Syurina EV , Peters RMH , et al . Non-communicable diseases-related stigma: A mixed-methods systematic review. Int J Environ Res Public Health 2020;17. doi:10.3390\/ijerph17186657","DOI":"10.3390\/ijerph17186657"},{"key":"2025120519312124000_14.6.e082398.62","doi-asserted-by":"publisher","DOI":"10.1177\/0969733014524760"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-082398","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:31:35Z","timestamp":1764991895000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-082398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":62,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,8]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/bmjopen-2023-082398"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-082398","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}