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Castro A, Lalonde-LeBlond G, Freitas Z, Arnaert A, Bitzas V, Kildea J, Moffatt K, Phillips D, Wiseblatt L, Hall AJ, Després V, Tsimicalis A. In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan. JMIR Nurs 2024; 7:e53078. [PMID: 38625735 PMCID: PMC11061788 DOI: 10.2196/53078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. OBJECTIVE This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. METHODS A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. RESULTS A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. CONCLUSIONS Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces.
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Affiliation(s)
- Aimee Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Zelda Freitas
- Professional Practice Directorate of Rehabilitation and Multidisciplinary Services, CIUSSS West-Central Montreal, Montreal, QC, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Geriatrics and Palliative Care, CIUSSS West-Central Montreal, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - Devon Phillips
- Palliative Care McGill, McGill University, Montreal, QC, Canada
| | | | - Audrey-Jane Hall
- Palliative Home-Care Society of Greater Montreal, Montreal, QC, Canada
| | - Véronique Després
- St-Raphaël Palliative Care Home and Day Centre, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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2
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Charlton P, Kean T, Liu RH, Nagel DA, Azar R, Doucet S, Luke A, Montelpare W, Mears K, Boulos L. Use of environmental scans in health services delivery research: a scoping review. BMJ Open 2021; 11:e050284. [PMID: 34758992 PMCID: PMC8587593 DOI: 10.1136/bmjopen-2021-050284] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To examine the extent and nature of evidence on the use of the environmental scan (ES) in the health services delivery literature. DESIGN Scoping review. METHODS This scoping review followed the five-stage scoping review methodology outlined by Khalil et al. A Peer Review of Electronic Search Strategies was completed. Seven electronic databases and the grey literature were searched. Pairs of researchers independently performed two levels of screening and data extraction. Data were analysed using qualitative content and thematic analysis. RESULTS Ninety-six studies were included in the scoping review. Researchers conducted ESs for many purposes, the most common being to examine the current state of programmes, services or policies. Recommendations were informed by ESs in 20% of studies. Most common data collection methods were literature review (71%), key informant or semistructured interviews (46%) and surveys (35%). Over half (53%) of the studies used a combination of passive (looking at information eg, literature, policies, guidelines) and active (looking for information eg, surveys, interviews) approaches to data collection. Person sources of data (eg, healthcare stakeholders, community representatives) and non-person sources of data (eg, documents, electronic databases, the web) were drawn on to a similar extent. The thematic analysis of the definitions/descriptions yielded several themes including instrument of discovery, knowledge synthesis, forward-looking and decision making. Research gaps identified included absence of a standard definition, inconsistencies in terminology and lack of guiding frameworks in the health services delivery context. CONCLUSION ESs were conducted to gather evidence and to help inform decision making on a range of policy and health services delivery issues across the continuum of care. Consistency in terminology, a consensus definition and more guidance on ES design may help provide structure for researchers and other stakeholders, and ultimately advance ES as a methodological approach. A working definition of ES in a health services delivery context is presented.
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Affiliation(s)
- Patricia Charlton
- Adjunct Faculty, Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Terri Kean
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Rebecca H Liu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Nagel
- College of Nursing, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Rima Azar
- Psychobiology of Stress and Health Lab, Psychology Department, Mount Allison University, Sackville, New Brunswick, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - William Montelpare
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Kim Mears
- Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
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Julien CA, Lavoie KL, Ribeiro PAB, Dragomir AI, Mercier LA, Garneau PY, Pescarus R, Bacon SL. Behavioral weight management interventions in metabolic and bariatric surgery: A systematic review and meta-analysis investigating optimal delivery timing. Obes Rev 2021; 22:e13168. [PMID: 33403754 DOI: 10.1111/obr.13168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
Metabolic and bariatric surgery (MBS) yields unprecedented clinical outcomes, though variability is high in weight change and health benefits. Behavioral weight management (BWM) interventions may optimize MBS outcomes. However, there is a lack of an evidence base to inform their use in practice, particularly regarding optimal delivery timing. This paper evaluated the efficacy of BWM conducted pre- versus post- versus pre- and post-MBS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and included pre- and/or post-operative BWM interventions in adults reporting anthropometric and/or body composition data. Thirty-six studies (2,919 participants) were included. Post-operative BWM yielded greater decreases in weight (standardized mean difference [SMD] = -0.41; 95% confidence interval [CI]: -0.766 to -0.049, p < 0.05; I2 = 93.5%) and body mass index (SMD = -0.60; 95% CI: -0.913 to -0.289, p < 0.001; I2 = 87.8%) relative to comparators. There was no effect of BWM delivered pre- or joint pre- and post-operatively. The risk of selection and performance bias was generally high. Delivering BWM after MBS appears to confer the most benefits on weight, though there was high variability in study characteristics and risk of bias across trials. This provides insight into the type of support that should be considered post-operatively.
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Affiliation(s)
- Cassandre A Julien
- Department of Psychology, University of Quebec at Montreal, Montréal, Canada.,Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Canada.,Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Anda I Dragomir
- Department of Psychology, University of Quebec at Montreal, Montréal, Canada.,Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Li Anne Mercier
- Department of Psychology, University of Quebec at Montreal, Montréal, Canada.,Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Pierre Y Garneau
- Department of Surgery, University of Montreal, Montréal, Canada.,General and Bariatric Surgery Division, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Radu Pescarus
- Department of Surgery, University of Montreal, Montréal, Canada.,General and Bariatric Surgery Division, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada.,Department of Health, Kinesiology & Applied Physiology, Concordia University, Montréal, Canada
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Giusti EM, Spatola CA, Brunani A, Kumbhare D, Oral A, Ilieva E, Kiekens C, Pietrabissa G, Manzoni GM, Imamura M, Castelnuovo G, Capodaglio P. ISPRM/ESPRM guidelines on Physical and Rehabilitation Medicine professional practice for adults with obesity and related comorbidities. Eur J Phys Rehabil Med 2020; 56:496-507. [PMID: 32293813 DOI: 10.23736/s1973-9087.20.06232-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The World Health Organization (WHO) has declared obesity as the largest global chronic health problem in adults. In the last years, attention has been drawn to rehabilitative interventions for patients with obesity. AIM The aim of this manuscript is to provide Physical and Rehabilitation Medicine (PRM) physicians with evidence-based recommendations for the rehabilitation of patients with overweight or obesity and related comorbidities. DESIGN Evidence-based guidelines. POPULATION Adults with overweight or obesity. METHODS Guidelines were based on GRADE and WHO recommendations. A comprehensive search of the available evidence about rehabilitation treatments for obesity was performed, and 17 separate systematic literature reviews were conducted. For each outcome, estimates of the effects of rehabilitation treatments were computed and employed along with an assessment of quality of evidence, desirable and undesirable effects, values and preferences to formulate the recommendations. Recommendations were reviewed by a consensus expert panel using a modified Delphi process. RESULTS We strongly recommend providing comprehensive multiprofessional and multidisciplinary interventions including exercise, diet and behavioral or cognitive-behavioral therapy. The nutritional component of these treatments should include diets with either a high-protein or a low-fat content. It is strongly recommended to prescribe frequent moderate aerobic exercise. We strongly recommend providing cognitive-behavioral interventions as the behavioral component of rehabilitation programs. CONCLUSIONS PRM physicians should lead multidisciplinary teams providing comprehensive and individualized rehabilitation programs for patients with overweight or obesity. These guidelines were endorsed by the International Society of Physical and Rehabilitation Medicine (ISPRM) and by the European Society of Physical and Rehabilitation Medicine (ESPRM).
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Affiliation(s)
- Emanuele M Giusti
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy - .,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy -
| | - Chiara A Spatola
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy
| | - Amelia Brunani
- Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy
| | - Dinesh Kumbhare
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Aydan Oral
- Department of Physical and Rehabilitation Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Sv. Georgi University Hospital, Plovdiv, Bulgaria
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven Belgium.,Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Marta Imamura
- Institute of Physical and Rehabilitation Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy
| | - Paolo Capodaglio
- Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy
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5
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Giusti E, Spatola CM, Brunani A, Kumbhare D, Oral A, Ilieva E, Kiekens C, Pietrabissa G, Manzoni G, Imamura M, Castelnuovo G, Capodaglio P. International society of physical and rehabilitation medicine/European society of physical and rehabilitation medicine guidelines on physical and rehabilitation medicine professional practice for adults with obesity and related comorbidities. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_6_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Zevin B, Dalgarno N, Martin M, Grady C, Matusinec J, Houlden R, Birtwhistle R, Smith K, Morkem R, Barber D. Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study. CMAJ Open 2019; 7:E738-E744. [PMID: 31836631 PMCID: PMC6910138 DOI: 10.9778/cmajo.20190072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Over 1 million Canadians have class II or III obesity; however, access to weight-loss interventions for these patients remains limited. The purpose of our study was to identify the barriers to accessing medical and surgical weight-loss interventions from the perspectives of 3 groups: family physicians, patients who were referred for weight-loss intervention and patients who were not referred for weight-loss intervention. METHODS Between November 2017 and May 2018, we conducted a qualitative exploratory research study using focus groups with family physicians and interviews with patients with class II or III obesity from 1 region in southern Ontario. We conducted a thematic analysis to identify emergent themes and used the barriers to change theory to classify the similarities and differences between the perspectives of family physicians, referred patients and nonreferred patients in first- and second-order barriers. RESULTS Seventeen family physicians participated in 7 focus groups (1-4 participants/group), and we interviewed 8 referred patients and 7 nonreferred patients. We identified lack of resource supports, logistics and lack of knowledge about weight-loss interventions as first-order barriers to change, and lack of knowledge about root causes of obesity, lack of patient readiness for change and family physicians' perceptions about surgical weight loss as second-order barriers to change. Family physicians and patients had similar perceptions regarding lack of resource supports in the community, logistical issues, family physicians' lack of knowledge regarding weight-loss interventions, patients' lack of motivation and family physicians' perceptions of bariatric surgery as being high risk. They differed regarding the root cause of obesity, with family physicians attributing obesity to multiple extrinsic and intrinsic causes, whereas patients believed obesity was largely due to intrinsic causes alone. INTERPRETATION It is important to address first- and second-order barriers to accessing weight-loss interventions through continuing professional development activities for family physicians to help ensure effective and timely treatment for patients with class II or III obesity and related comorbidities.
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Affiliation(s)
- Boris Zevin
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Nancy Dalgarno
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Mary Martin
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Colleen Grady
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Jacob Matusinec
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Robyn Houlden
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Richard Birtwhistle
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Karen Smith
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - Rachael Morkem
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont
| | - David Barber
- Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont.
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7
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Sharma AM, Bélanger A, Carson V, Krah J, Langlois M, Lawlor D, Lepage S, Liu A, Macklin DA, MacKay N, Pakseresht A, Pedersen SD, Ramos Salas X, Vallis M. Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study. Clin Obes 2019; 9:e12329. [PMID: 31294535 PMCID: PMC6771494 DOI: 10.1111/cob.12329] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
Obesity is a chronic disease with a significant and growing impact on Canadians. The "Awareness, Care and Treatment In Obesity MaNagement" (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m2 , based on self-reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross-sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a "chronic medical condition" by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long-term weight loss methods tried and/or recommended were "improvements in eating habits" (PwO 38%; HCP 63%) and "being more active" (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence-based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.
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Affiliation(s)
- Arya M. Sharma
- Department of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - André Bélanger
- Le Groupe de Médecine Familiale ValcartierCourceietteQuebecCanada
| | | | - Jodi Krah
- Obesity CanadaNiagara RegionOntarioCanada
| | | | - Diana Lawlor
- Obesity and Bariatric SurgeryHalifaxNova ScotiaCanada
| | | | - Aiden Liu
- Novo Nordisk Canada Inc.MississaugaOntarioCanada
| | | | | | | | - Sue D. Pedersen
- C‐ENDO Diabetes and Endocrinology ClinicCalgaryAlbertaCanada
| | | | - Michael Vallis
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
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8
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Campbell T, Rash JA, Vallis M. Appreciating the Importance of Unmet Needs Associated With Obesity in Cardiac Rehabilitation: A Call for Critical Improvement in Program Availability. Can J Cardiol 2019; 35:684-687. [PMID: 31151697 DOI: 10.1016/j.cjca.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
| | - Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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9
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Aboueid S, Meyer SB. Factors affecting access and use of preventive and weight management care: A public health lens. Healthc Manage Forum 2019; 32:136-142. [PMID: 30943766 DOI: 10.1177/0840470418824345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is an important risk factor for various chronic diseases. While people with obesity use the health system more and incur higher costs, they may forego using preventive care services (e.g., gynecological cancer screenings) due to issues of service use and service access. The aim of this paper was to use a public health lens to elucidate system level factors that affect healthcare access and utilization for preventive and weight management care by patients with obesity. Some elucidated factors include lack of access to a Primary Care Provider (PCP) and multidisciplinary healthcare settings, gender of the PCP, duration of medical visits and health professionals' attitudes about obesity. We highlight potential strategies for leaders to use when improving access and use of health services by patients with obesity in Canada and the need for future empirical studies in this research area.
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Affiliation(s)
- Stephanie Aboueid
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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10
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Fong AJ, Jones JM, Faulkner G, Sabiston CM. Exploring cancer centres for physical activity and sedentary behaviour support for breast cancer survivors. ACTA ACUST UNITED AC 2018; 25:e365-e372. [PMID: 30464686 DOI: 10.3747/co.25.3858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Up to 90% of breast cancer survivors report low levels of physical activity (pa) and spend approximately 70% of the day in sedentary behaviour. Survivors might not be receiving information about the health benefits of pa and the consequences of sedentary behaviour in the context of their cancer. The primary purpose of the present study was to evaluate cancer centres for pa and sedentary behaviour information and infrastructure. A secondary aim was to evaluate the quality of the information that is accessible to breast cancer survivors in cancer centres. Methods A built-environment scan of the 14 regional cancer centres in Ontario and an evaluation of the text materials about pa available at the cancer centres were completed. Data analyses included descriptive statistics, proportions, and inter-rater reliability. Results The infrastructure of the cancer centres provided few opportunities for dissemination of information related to pa through signs and printed notices. Televisions were present in all waiting rooms, which could provide a unique opportunity for dissemination of information about pa and sedentary behaviour. Text materials were rated as trustworthy, used some behaviour change techniques (for example, information about the consequences of lack of pa, barrier identification, and setting graded tasks), and were aesthetically pleasing. Conclusions These findings represent areas for knowledge dissemination both for the centre and for resources that could be further improved.
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Affiliation(s)
- A J Fong
- At the time of the study: Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON; currently: School of Kinesiology and Health Studies, Queen's University, Kingston, ON
| | - J M Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - G Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC
| | - C M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON
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Baillot A, Mampuya WM, Dionne IJ, Comeau E, Méziat-Burdin A, Langlois MF. Impacts of Supervised Exercise Training in Addition to Interdisciplinary Lifestyle Management in Subjects Awaiting Bariatric Surgery: a Randomized Controlled Study. Obes Surg 2017; 26:2602-2610. [PMID: 27038045 DOI: 10.1007/s11695-016-2153-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Experts recommend physical activity (PA) to optimize bariatric surgery (BS) results. However, evidence on the effect of PA before BS is missing. The aim of this study was to assess the impact of adding a Pre-Surgical Exercise Training (PreSET) to an interdisciplinary lifestyle intervention on physical fitness, quality of life, PA barriers, and anthropometric parameters of subjects awaiting BS. METHODS Thirty candidates for BS (43.2 ± 9.2 years, 47.5 ± 8.1 kg/m2) have been randomized in two groups: one group following the PreSET (endurance and strength training) and another receiving usual care. Before and after 12 weeks, we assessed physical fitness with a battery of tests (symptom-limited exercise test, 6-min walk test (6MWT), sit-to-stand test, half-squat test, and arm curl test), quality of life with the laval questionnaire, and PA barriers with the physical exercise belief questionnaire. RESULTS One control group subject abandoned the study. Subjects in the PreSET group participated in 60.0 % of the supervised exercise sessions proposed. Results showed significant improvements in the 6MWT (17.4 ± 27.2 vs. -16.4 ± 42.4 m; p = 0.03), half-squat test (17.1 ± 17.9 vs. -0.9 ± 14.5 s; p = 0.05), arm curl repetitions (4.8 ± 2.3 vs. 1.0 ± 4.1; p = 0.01), social interaction score (10.7 ± 12.5 vs. -2.1 ± 11.0 %; p = 0.02), and embarrassment (-15.6 ± 10.2 vs. -3.1 ± 17.8 %; p = 0.02) in completers (n = 8) compared to the non-completers (n = 21). No significant difference between groups in BMI and other outcomes studied was observed after the intervention. CONCLUSIONS Adding a PreSET to an individual lifestyle counselling intervention improved physical fitness, social interactions, and embarrassment. Post-surgery data would be interesting to confirm these benefits on the long term.
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Affiliation(s)
- Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, Quebec, Canada.,Research Institute of the Montfort Hospital, Ottawa, Ontario, Canada
| | - Warner M Mampuya
- Division of Cardiology, Department of Medicine, University of Sherbrooke, Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle J Dionne
- Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Faculty of Physical Education and Sports, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Emilie Comeau
- Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anne Méziat-Burdin
- Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
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Obesity services planning framework for interprofessional primary care organizations. Prim Health Care Res Dev 2016; 18:135-147. [DOI: 10.1017/s1463423616000372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimWe report on a formative project to develop an organization-level planning framework for obesity prevention and management services.BackgroundIt is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.MethodsThe initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft.FindingsProviders identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education.ConclusionsJoint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.
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Baillot A, Romain AJ, Boisvert-Vigneault K, Audet M, Baillargeon JP, Dionne IJ, Valiquette L, Chakra CNA, Avignon A, Langlois MF. Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis. PLoS One 2015; 10:e0119017. [PMID: 25830342 PMCID: PMC4382170 DOI: 10.1371/journal.pone.0119017] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/08/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals. METHODS An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I². RESULTS Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose. CONCLUSIONS Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.
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Affiliation(s)
- Aurélie Baillot
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ahmed J. Romain
- Unit of Nutrition and Diabetes, Department of Endocrinology-Nutrition and Diabetes, University Hospital of Montpellier, Montpellier, France
| | - Katherine Boisvert-Vigneault
- Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélisa Audet
- Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean Patrice Baillargeon
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle J. Dionne
- Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec, Canada
| | - Claire Nour Abou Chakra
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec, Canada
| | - Antoine Avignon
- Unit of Nutrition and Diabetes, Department of Endocrinology-Nutrition and Diabetes, University Hospital of Montpellier, Montpellier, France
- INSERM U1046, Physiology and experimental medicine of heart and muscles, University of Montpellier, Montpellier, France
| | - Marie-France Langlois
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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