{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:57:54Z","timestamp":1790823474304,"version":"4.1.0"},"reference-count":55,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Region Zealand, National Cancer Plan IV","award":["grant number 20-082, 2020]."],"award-info":[{"award-number":["grant number 20-082, 2020]."]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,6]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Objectives<\/jats:title>\n This study aimed to investigate patients\u2019 use of electronic Patient-Reported Outcome Measures (ePROMs) and understand the demographic and clinical factors that may be correlated with patient responses to the BREAST-Q at the preoperative stage of breast cancer. The BREAST-Q is a PROM in questionnaire format, developed and validated to assess satisfaction and quality of life for breast surgery patients.The hypothesis tested is that considering disparities in geography, age and education among responders is essential for capturing a diverse patient population in future Patent-Reported Outcome Measures initiatives, examining how these characteristics are associated with Patent-Reported Outcome Measures utilisation and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Quantitative descriptive study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Electronic Patient-Reported Outcome Measures were collected between 6 September 2021 and 5 September 2022 from patients recruited from an outpatient clinic at a Plastic- and Breast Surgery Department at a University Hospital in Denmark.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Participants include a total of 629 Danish-speaking women diagnosed with breast cancer and scheduled for breast cancer surgery, with a final participation rate of 468.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Preoperative ePROMs and demographic data were collected between September 2020 and 2021 through patients\u2019 secure national digital post-box.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n \n Demographic variables of both responders and non-responders were assessed using t-tests, Mann-Whitney U tests and \u03c7\n 2<\/jats:sup>\n tests. Linear regression models were employed to determine the demographic variables associated with BREAST-Q subscale scores.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The response rate for ePROMs was 72.5% with a median age of responders at 62 years. Older patients reported lower breast satisfaction (unadjusted coefficient b\n u<\/jats:sub>\n =\u22120.26 (95% CI \u22120.44; \u22120.07), p=0.006) but better physical well-being (adjusted coefficient b\n a<\/jats:sub>\n =0.23 (0.08; 0.37), p<0.001). Lower educational achievement was correlated with reduced breast satisfaction and psychosocial and sexual well-being; for example, patients with a master\u2019s\/doctoral level education scored 14.29 points higher in psychosocial well-being (95%\u2009CI 6.50; 22.07, p<0.001) compared with those with lower secondary education. Cohabiting patients reported psychosocial well-being scores approximately four points higher than those living alone (b\n a<\/jats:sub>\n =3.91 (0.06; 7.75), p=0.046). Body mass index (BMI) was negatively associated with sexual well-being, with a 0.75-point decline per additional BMI point (b\n a<\/jats:sub>\n =\u22120.75, (-1.12; \u22120.37), p<0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The present study demonstrates a positive attitude towards completing BREAST-Q as ePROMs among women diagnosed with breast cancer in the investigated region in Denmark. However, completion rates for ePROMs varied by demographic factors such as age, marital status and access to healthcare. Younger, more educated, married patients with lower BMI who lived near major cities were more likely to report better pretreatment outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-091122","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T01:36:40Z","timestamp":1735868200000},"page":"e091122","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Demographic and clinical impact on preoperative BREAST-Q ePROM completion and baseline outcomes in women undergoing breast cancer surgery: a quantitative descriptive study at a Danish university hospital"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4570-6010","authenticated-orcid":false,"given":"Julie Hougaard","family":"Pr\u00fcsse","sequence":"first","affiliation":[{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark"},{"name":"Department of Cardiology, Zealand University Hospital, Roskilde, Denmark"},{"name":"University College Absalon, Slagelse, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-4674","authenticated-orcid":false,"given":"Karin","family":"Piil","sequence":"additional","affiliation":[{"name":"Department of People and Technology, Roskilde University, Roskilde, Denmark"},{"name":"Dept. of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark"},{"name":"Department of Public Health, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lone","family":"Bak Hansen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte Gebhard","family":"\u00d8rsted","sequence":"additional","affiliation":[{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker J\u00fcrgen","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mejldal","sequence":"additional","affiliation":[{"name":"Open\u2014Open Patient Data Explorative Network, Odense University Hospital, Odense, Syddanmark, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3692-2723","authenticated-orcid":false,"given":"Stine","family":"Thestrup Hansen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"2025121221341939000_15.1.e091122.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.04.007"},{"key":"2025121221341939000_15.1.e091122.2","doi-asserted-by":"crossref","unstructured":"Nielsen AS , Hanna L , Larsen BF , et al . Readiness, acceptance and use of digital patient reported outcome in an outpatient clinic. Health Informatics J 2022;28. doi:10.1177\/14604582221106000","DOI":"10.1177\/14604582221106000"},{"key":"2025121221341939000_15.1.e091122.3","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s11136-018-2048-4","article-title":"Implementing patient-reported outcome measures in clinical practice: a companion guide to the ISOQOL user\u2019s guide","volume":"28","author":"Chan","year":"2019","journal-title":"Qual Life Res"},{"key":"2025121221341939000_15.1.e091122.4","first-page":"61","article-title":"Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs)","volume":"6","author":"Weldring","year":"2013","journal-title":"Health Serv Insights"},{"key":"2025121221341939000_15.1.e091122.5","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.001067"},{"key":"2025121221341939000_15.1.e091122.6","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7525-4-79","article-title":"Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance","volume":"4","year":"2006","journal-title":"Health Qual Life Outcomes"},{"key":"2025121221341939000_15.1.e091122.7","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1111\/cas.15329","article-title":"Feasibility study on collecting patient-reported outcomes from breast cancer patients using the LINE-ePRO system","volume":"113","author":"Hayashida","year":"2022","journal-title":"Cancer Sci"},{"key":"2025121221341939000_15.1.e091122.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-005-6030-4"},{"key":"2025121221341939000_15.1.e091122.9","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181aee807"},{"key":"2025121221341939000_15.1.e091122.10","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1380"},{"key":"2025121221341939000_15.1.e091122.11","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1007\/s11136-018-1866-8","article-title":"Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis","volume":"27","author":"Schmidt","year":"2018","journal-title":"Qual Life Res"},{"key":"2025121221341939000_15.1.e091122.12","unstructured":"World Health Organization . Breast cancer (Tokyo, Japan), 2021. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer [Accessed 11 Nov 2021]."},{"key":"2025121221341939000_15.1.e091122.13","unstructured":"Sundhedsstyrelsen [Danish Health Authority] . Screening for brystkr\u00e6ft, Available: http:\/\/www.sst.dk\/da\/Borger\/Sygdomme-og-lidelser\/Kr\u00e6ftsygdom\/Screening-for-kraeft\/Brystkraeft [Accessed 26 Apr 2024]."},{"key":"2025121221341939000_15.1.e091122.14","first-page":"231","article-title":"Living with body image changes following completion of cancer treatment","volume":"30","author":"Fitch","year":"2020","journal-title":"Can Oncol Nurs J"},{"key":"2025121221341939000_15.1.e091122.15","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ejon.2012.09.002","article-title":"Aspects of body image after mastectomy due to breast cancer - a two-year follow-up study","volume":"17","author":"Fallbj\u00f6rk","year":"2013","journal-title":"Eur J Oncol Nurs"},{"key":"2025121221341939000_15.1.e091122.16","doi-asserted-by":"crossref","first-page":"145","DOI":"10.5152\/tjbh.2016.2913","article-title":"Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research","volume":"12","author":"Ko\u00e7an","year":"2016","journal-title":"J Breast Health"},{"key":"2025121221341939000_15.1.e091122.17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/tbj.12543","article-title":"Beyond Quantitative Measurement of Breast Reconstruction Outcomes: Evaluation of Nipple-Sparing Mastectomy and the Breast-Q","volume":"22","author":"Wommack","year":"2016","journal-title":"Breast J"},{"key":"2025121221341939000_15.1.e091122.18","doi-asserted-by":"crossref","first-page":"3304","DOI":"10.1111\/jan.15309","article-title":"\u201cAt least there is something in my bra\u201d: A qualitative study of women\u2019s experiences with oncoplastic breast surgery","volume":"78","author":"Hansen","year":"2022","journal-title":"J Adv Nurs"},{"key":"2025121221341939000_15.1.e091122.19","unstructured":"BREAST-Q . Q-Portfolio - MEASURING WHAT MATTERS TO PATIENTS, 2016. Available: https:\/\/qportfolio.org\/breast-q\/ [Accessed 26 Apr 2024]."},{"key":"2025121221341939000_15.1.e091122.20","doi-asserted-by":"crossref","DOI":"10.1097\/GOX.0000000000001904","article-title":"BREAST-Q Measurement of the Patient Perspective in Oncoplastic Breast Surgery: A Systematic Review","volume":"6","author":"Liu","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025121221341939000_15.1.e091122.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-065110","article-title":"Electronic patient-reported outcome measures to enable systematic follow-up in treatment and care of women diagnosed with breast cancer: a feasibility study protocol","volume":"12","author":"Thestrup Hansen","year":"2022","journal-title":"BMJ Open"},{"key":"2025121221341939000_15.1.e091122.22","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.ciresp.2019.10.004","article-title":"Questionnaire","volume":"98","author":"Builes Ram\u00edrez","year":"2020","journal-title":"Cir Esp (Eng Ed)"},{"key":"2025121221341939000_15.1.e091122.23","doi-asserted-by":"crossref","DOI":"10.1097\/GOX.0000000000005124","article-title":"Beyond Physical Well-being: Exploring Demographic Variances in Psychosocial Well-being before Breast Reconstruction","volume":"11","author":"Kebede","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025121221341939000_15.1.e091122.24","unstructured":"The Danish Health Data Authority . Nye Kr\u00e6fttilf\u00e6lde, Available: https:\/\/www.esundhed.dk\/Emner\/Kraeft\/Nye-kraefttilfaelde#tabpanelF5861B83CF514FF491209766693ABE7E [Accessed 21 Nov 2022]."},{"key":"2025121221341939000_15.1.e091122.25","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11136-023-03505-y","article-title":"Patient adherence to patient-reported outcome measure (PROM) completion in clinical care: current understanding and future recommendations","volume":"33","author":"Unni","year":"2024","journal-title":"Qual Life Res"},{"key":"2025121221341939000_15.1.e091122.26","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2021-1410"},{"key":"2025121221341939000_15.1.e091122.27","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160975"},{"key":"2025121221341939000_15.1.e091122.28","doi-asserted-by":"crossref","DOI":"10.1186\/s41687-022-00428-z","article-title":"Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States","volume":"6","author":"Hyland","year":"2022","journal-title":"J Patient Rep Outcomes"},{"key":"2025121221341939000_15.1.e091122.29","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-66","article-title":"Estimating recruitment rates for routine use of patient reported outcome measures and the impact on provider comparisons","volume":"14","author":"Hutchings","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2025121221341939000_15.1.e091122.30","unstructured":"Region Sj\u00e6lland [Region Zealand] . Sundhedsprofil 2021 for Region Sj\u00e6lland og kommuner - \u2018hvordan har du det?,\u2019 2022. Available: http:\/\/publikationer.regionsjaelland.dk\/data-og-udviklingsstoette\/sundhedsprofil-2021\/?page=2 [Accessed 2 Jan 2023]."},{"key":"2025121221341939000_15.1.e091122.31","unstructured":"Sundhedsstyrelsen [Danish Health Authority] . Danskernes sundhed den nationale sundhedsprofil 2021. 2022. Available: www.sst.dk [Accessed 8 Sep 2022]."},{"key":"2025121221341939000_15.1.e091122.32","unstructured":"Pusic AL , Klassen A , Cano S . BREAST-q version 2.0 a guide for researchers and clinicians."},{"key":"2025121221341939000_15.1.e091122.33","doi-asserted-by":"crossref","unstructured":"Loon Ong W , Schouwenburg MG , van Bommel AC , et al . A Standard Set of Value-Based Patient-Centered Outcomes for Breast Cancer The International Consortium for Health Outcomes Measurement (ICHOM) Initiative Supplemental content. JAMA 2016. doi:10.1001\/jamaoncol.2016.4851","DOI":"10.1001\/jamaoncol.2016.4851"},{"key":"2025121221341939000_15.1.e091122.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025121221341939000_15.1.e091122.35","unstructured":"Agency for Digital Government . Digital Post, Available: https:\/\/lifeindenmark.borger.dk\/apps-and-digital-services\/Digital-Post [Accessed 29 Mar 2024]."},{"key":"2025121221341939000_15.1.e091122.36","doi-asserted-by":"crossref","unstructured":"Verma JP , Abdel-Salam A-S . Testing Statistical Assumptions in Research. John Wiley & Sons, 2019.","DOI":"10.1002\/9781119528388"},{"key":"2025121221341939000_15.1.e091122.37","unstructured":"Danmarks Statistik [Statistics Denmark] . Inddeling af Danmarks kommuner, 2018. Available: https:\/\/www.dst.dk\/Site\/Dst\/SingleFiles\/GetArchiveFile.aspx?fi=3151484056&fo=0&ext=kvaldel"},{"key":"2025121221341939000_15.1.e091122.38","unstructured":"Kirchgeorg M . International Standard Classification of Education. UNESCO Inst Stat 2011;88."},{"key":"2025121221341939000_15.1.e091122.39","unstructured":"StataCorp . Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC, 2021."},{"key":"2025121221341939000_15.1.e091122.40","doi-asserted-by":"crossref","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: conceptualising access at the interface of health systems and populations","volume":"12","author":"Levesque","year":"2013","journal-title":"Int J Equity Health"},{"key":"2025121221341939000_15.1.e091122.41","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1007\/s10389-022-01767-3","article-title":"Essential barriers and considerations for the implementation of electronic patient-reported outcome (ePRO) measures in oncological practice: contextualizing the results of a feasibility study with existing literature","volume":"31","author":"Kiderlen","year":"2023","journal-title":"J Public Health (Berl)"},{"key":"2025121221341939000_15.1.e091122.42","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11136-022-03213-z","article-title":"Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q","volume":"32","author":"Nelson","year":"2023","journal-title":"Qual Life Res"},{"key":"2025121221341939000_15.1.e091122.43","unstructured":"Agency for Digital Government -, Finansministeriet [Danish Ministry of Finance] . Statistik om Digital Post, Available: https:\/\/digst.dk\/it-loesninger\/digital-post\/om-loesningen\/tal-og-statistik"},{"key":"2025121221341939000_15.1.e091122.44","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"2025121221341939000_15.1.e091122.45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pdig.0000279","article-title":"Digital literacy as a new determinant of health: A scoping review","volume":"2","author":"Arias L\u00f3pez","year":"2023","journal-title":"PLOS Digit Health"},{"key":"2025121221341939000_15.1.e091122.46","doi-asserted-by":"crossref","DOI":"10.1186\/s12911-016-0359-3","article-title":"Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies","volume":"16","author":"O\u2019Connor","year":"2016","journal-title":"BMC Med Inform Decis Mak"},{"key":"2025121221341939000_15.1.e091122.47","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1080\/0284186X.2022.2143278","article-title":"Socioeconomic inequality in cancer in the Nordic countries. A systematic review","volume":"61","author":"Ammitzb\u00f8ll","year":"2022","journal-title":"Acta Oncol"},{"key":"2025121221341939000_15.1.e091122.48","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1080\/0284186X.2020.1749880","article-title":"Expectations to Patient-Reported Outcome (PRO) in Oncology \u2013 PRO for a purpose, when and how?","volume":"59","author":"Pappot","year":"2020","journal-title":"Acta Oncol"},{"key":"2025121221341939000_15.1.e091122.49","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.jss.2022.07.042","article-title":"Collection and Utilization of Patient-Reported Outcome Measures in a Colorectal Surgery Clinic","volume":"280","author":"Harrison","year":"2022","journal-title":"J Surg Res"},{"key":"2025121221341939000_15.1.e091122.50","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06588-9"},{"key":"2025121221341939000_15.1.e091122.51","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2007.00231.x"},{"key":"2025121221341939000_15.1.e091122.52","doi-asserted-by":"crossref","unstructured":"Muehlhausen W , Doll H , Quadri N , et al . Equivalence of electronic and paper administration of patient-reported outcome measures: a systematic review and meta-analysis of studies conducted between 2007 and 2013. Health Qual Life Outcomes 2015;13. doi:10.1186\/s12955-015-0362-x","DOI":"10.1186\/s12955-015-0362-x"},{"key":"2025121221341939000_15.1.e091122.53","unstructured":"Finansministeriet [Danish Ministry of Finance] . Danmarks digitaliseringsstrategi - sammen om den digitale udvikling. 2022. Available: https:\/\/www.regeringen.dk\/media\/11324\/danmarks-digitaliseringsstrategidigitaliseringsstrategidigitaliseringsstrategidigitaliseringsstrategi-sammen-om-den-digitale-udvikling.pdf [Accessed 30 Mar 2023]."},{"key":"2025121221341939000_15.1.e091122.54","unstructured":"Regioner D . Lighed i sundhed, Available: https:\/\/www.regioner.dk\/sundhed\/lighed-i-sundhed"},{"key":"2025121221341939000_15.1.e091122.55","doi-asserted-by":"crossref","first-page":"E273","DOI":"10.1097\/NCC.0000000000000738","article-title":"\u201cI Am Sure That They Use My PROM Data for Something Important.\u201d A Qualitative Study About Patients\u2019 Experiences From a Hematologic Outpatient Clinic","volume":"43","author":"Thestrup Hansen","year":"2020","journal-title":"Cancer Nurs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-091122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:34:32Z","timestamp":1765604072000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-091122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,2]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2024-091122"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-091122","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}