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Lake JD, Barnsley J, Lofters A, Austin Z. A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study. Res Social Adm Pharm 2024:S1551-7411(24)00152-9. [PMID: 38704302 DOI: 10.1016/j.sapharm.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams. OBJECTIVES This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams. METHODS This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case. RESULTS Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist. CONCLUSION Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.
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Affiliation(s)
- Jennifer D Lake
- Leslie Dan Faculty of Pharmacy, University of Toronto, 639 - 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Janet Barnsley
- Institute of Health Policy Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Aisha Lofters
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, 707 - 144 College Street, Toronto, ON, M5S 3M2, Canada
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Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Policies in Canada fail to address disparities in access to person-centred osteoarthritis care: a content analysis. BMC Health Serv Res 2024; 24:522. [PMID: 38664819 PMCID: PMC11044343 DOI: 10.1186/s12913-024-10966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women. METHODS We used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack's six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women. RESULTS We included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups. CONCLUSIONS Canadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.
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Affiliation(s)
- Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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O'Brien MA, Lofters A, Wall B, Elliott R, Makuwaza T, Pietrusiak MA, Grunfeld E, Riordan B, Snider C, Pinto AD, Manca D, Sopcak N, Cornacchi SD, Huizinga J, Sivayoganathan K, Donnelly PD, Selby P, Kyle R, Rabeneck L, Baxter NN, Tinmouth J, Paszat L. Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents. BMC Health Serv Res 2024; 24:427. [PMID: 38575938 PMCID: PMC10993474 DOI: 10.1186/s12913-024-10853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. METHODS We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. RESULTS Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. CONCLUSIONS Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. TRIAL REGISTRATION #NCT03052959, 10/02/2017.
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Affiliation(s)
- Mary Ann O'Brien
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - Becky Wall
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Regina Elliott
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Tutsirai Makuwaza
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Mary-Anne Pietrusiak
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Ave, Suite 510, Toronto, ON, M5G 0A3, Canada
| | - Bernadette Riordan
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Cathie Snider
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 61 Queen St E #3, Toronto, ON, M5C 2T2, Canada
| | - Donna Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, 6 - 10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Sylvie D Cornacchi
- Department of Pediatrics, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada
| | - Joanne Huizinga
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Kawsika Sivayoganathan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Peter D Donnelly
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, UK
| | - Peter Selby
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Centre for Addiction and Mental Health, 1025 Queen Street West, 5Th Floor, Toronto, ON, M6J 1H4, Canada
| | - Robert Kyle
- Durham Region Health Department, Regional Municipality of Durham, 605 Rossland Road East, Whitby, ON, L1N 6A3, Canada
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - Nancy N Baxter
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia
| | - Jill Tinmouth
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lawrence Paszat
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Williams KKA, Baidoobonso S, Haggerty J, Lofters A, Adams AM. Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context. Ethn Health 2024; 29:343-352. [PMID: 38332736 DOI: 10.1080/13557858.2024.2311429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
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Affiliation(s)
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montréal, Canada
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Tammemägi MC, Darling GE, Schmidt H, Walker MJ, Langer D, Leung YW, Nguyen K, Miller B, Llovet D, Evans WK, Buchanan DN, Espino-Hernandez G, Aslam U, Sheppard A, Lofters A, McInnis M, Dobranowski J, Habbous S, Finley C, Luettschwager M, Cameron E, Bravo C, Banaszewska A, Creighton-Taylor K, Fernandes B, Gao J, Lee A, Lee V, Pylypenko B, Yu M, Svara E, Kaushal S, MacNiven L, McGarry C, Della Mora L, Koen L, Moffatt J, Rey M, Yurcan M, Bourne L, Bromfield G, Coulson M, Truscott R, Rabeneck L. Risk-based lung cancer screening performance in a universal healthcare setting. Nat Med 2024; 30:1054-1064. [PMID: 38641742 DOI: 10.1038/s41591-024-02904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.
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Affiliation(s)
- Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Brock University, St. Catharines, ON, Canada.
| | - Gail E Darling
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Heidi Schmidt
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Deanna Langer
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Yvonne W Leung
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Kathy Nguyen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Beth Miller
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Diego Llovet
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Erin Cameron
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Caroline Bravo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Alex Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Van Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Monica Yu
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Erin Svara
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Lynda MacNiven
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Liz Koen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Laurie Bourne
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
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Shuldiner J, Lam E, Shah N, Grimshaw J, Desveaux L, Heisey R, Taccone MS, Taljaard M, Thavorn K, Hodgson D, Gupta S, Lofters A, Ivers N, Nathan PC. Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario. Implement Sci 2024; 19:19. [PMID: 38395903 PMCID: PMC10885391 DOI: 10.1186/s13012-024-01347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Childhood cancer treatment while often curative, leads to elevated risks of morbidity and mortality. Survivors require lifelong periodic surveillance for late effects of treatment, yet adherence to guideline-recommended tests is suboptimal. We created ONLOOP to provide adult survivors of childhood cancer with detailed health information, including summaries of their childhood cancer treatment and recommended surveillance tests for early detection of cardiomyopathy, breast cancer, and/or colorectal cancer, with personalized reminders over time. METHODS This is an individually randomized, registry-based pragmatic trial with an embedded process and economic evaluation to understand ONLOOP's impact and whether it can be readily implemented at scale. All adult survivors of childhood cancer in Ontario overdue for guideline-recommended tests will be randomly assigned to one of two arms: (1) intervention or (2) delayed intervention. A letter of information and invitation will detail the ONLOOP program. Those who sign up will receive a personalized toolkit and a screening reminder 6 months later. With the participants' consent, ONLOOP will also send their primary care clinician a letter detailing the recommended tests and a reminder 6 months later. The primary outcome will be the proportion of survivors who complete one or more of the guideline-recommended cardiac, breast, or colon surveillance tests during the 12 months after randomization. Data will be obtained from administrative databases. The intent-to-treat principle will be followed. Based on our analyses of administrative data, we anticipate allocating at least 862 individuals to each trial arm, providing 90% power to detect an absolute increase of 6% in targeted surveillance tests completed. We will interview childhood cancer survivors and family physicians in an embedded process evaluation to examine why and how ONLOOP achieved success or failed. A cost-effectiveness evaluation will be performed. DISCUSSION The results of this study will determine if ONLOOP is effective at helping adult survivors of childhood cancer complete their recommended surveillance tests. This study will also inform ongoing provincial programs for this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT05832138.
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Affiliation(s)
- Jennifer Shuldiner
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
| | - Emily Lam
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Nida Shah
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Jeremy Grimshaw
- University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1286, Ottawa, ON, K1H 8L6, Canada
| | - Laura Desveaux
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B, Canada
| | - Ruth Heisey
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Michael S Taccone
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health-University of Ottawa, Clinical Epidemiology-Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, ON, Canada
| | - Sumit Gupta
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Aisha Lofters
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Noah Ivers
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Paul C Nathan
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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7
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Iziduh S, Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall DA, Gagliardi AR. Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey. BMJ Open 2024; 14:e080301. [PMID: 38373862 PMCID: PMC10897840 DOI: 10.1136/bmjopen-2023-080301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Osteoarthritis (OA) prevalence, severity and related comorbid conditions are greater among women compared with men, but women, particularly racialised women, are less likely than men to access OA care. We aimed to prioritise strategies needed to reduce inequities in OA management. DESIGN Delphi survey of 28 strategies derived from primary research retained if at least 80% of respondents rated 6 or 7 on a 7-point Likert scale. SETTING Online. PARTICIPANTS 35 women of diverse ethno-cultural groups and 29 healthcare professionals of various specialties from across Canada. RESULTS Of the 28 initial and 3 newly suggested strategies, 27 achieved consensus to retain: 20 in round 1 and 7 in round 2. Respondents retained 7 patient-level, 7 clinician-level and 13 system-level strategies. Women and professionals agreed on all but one patient-level strategy (eg, consider patients' cultural needs and economic circumstances) and all clinician-level strategies (eg, inquire about OA management needs and preferences). Some discrepancies emerged for system-level strategies that were more highly rated by women (eg, implement OA-specific clinics). Comments revealed general support among professionals for system-level strategies provided that additional funding or expanded scope of practice was targeted to only formally trained professionals and did not reduce funding for professionals who already managed OA. CONCLUSIONS We identified multilevel strategies that could be implemented by healthcare professionals, organisations or systems to mitigate inequities and improve OA care for diverse women.
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Affiliation(s)
- Sharon Iziduh
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Angela Abenoja
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vandana Ahluwalia
- William Osler Health System - Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Marisa Battistella
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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8
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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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9
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Dunstan B, Buchanan F, Maybee A, Lofters A, Sayani A. #HowNotToDoPatientEngagement: the engaging with purpose patient engagement framework based on a twitter analysis of community perspectives on patient engagement. Res Involv Engagem 2023; 9:119. [PMID: 38093323 PMCID: PMC10717861 DOI: 10.1186/s40900-023-00527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Evaluation of patient engagement practices are frequently researcher-driven, researcher-funded, and asymmetric in power dynamics. Little to no literature on patient experiences in patient engagement exist that is are not framed by institutionally-driven research inquiries (i.e., from the lens of a research team lead, or healthcare administrative setting). Understanding these perspectives can help us understand: (i)what matters to patients when they are engaged in research; (ii)why it matters to them, and(iii) how to improve patient engagement practices, so that the needs and priorities of patients are consistently met. METHODS This is a patient partner-initiated study. Study authors (including patient partners) conducted a conventional and summative content analysis of textual data retrieved from a highly engaged conversation on Twitter regarding the hashtags #HowNotToDoPatientEngagement and #HowToDoPatientEngagement posted between February 2018 to June 2021. Twitter is a microblogging platform that allows for free-flowing discussions between users not pre-bound by specific community groupings (like within that of Facebook). RESULTS A total of 276 tweets were retrieved from 178 separate contributors across seven geographical locations. Four stakeholder groups were identified. We generated 24 codes, nine subthemes and five overarching themes: respect, support, collaboration, inclusivity and impact. Four of these themes are closely aligned with the Strategy for Patient Oriented (SPOR) Patient Engagement framework. We identify impact as a separate and new theme. INTERPRETATION Based on our findings we offer the Engaging with Purpose Patient Engagement Framework that defines and describes respect, support, collaboration, inclusivity and impact as five key pillars of meaningful patient engagement.
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Affiliation(s)
- Brianna Dunstan
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | | | | | - Aisha Lofters
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ambreen Sayani
- Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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10
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
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Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
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11
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Lofters A, Prakash V, Devotta K, Vahabi M. The potential benefits of "community champions" in the healthcare system. Healthc Manage Forum 2023; 36:382-387. [PMID: 37268592 PMCID: PMC10604418 DOI: 10.1177/08404704231179911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In a study to understand acceptability and uptake of Human Papilloma Virus (HPV) self-sampling, we engaged community champions to lead recruitment and other study activities. This article describes qualitative findings relevant to the role of the community champion. We found that community champions were critical to promoting awareness about and encouraging cervical screening and HPV self-sampling. They were well-connected community members who had healthcare backgrounds, which created trust in their messages. They were highly effective at encouraging screening because of their education and cultural congruency, combined with the time for thorough and clear explanations. Women had an inherent level of comfort with the community champions that often did not exist with their physician. The community champions were seen as being able to address some of the barriers that exist within the healthcare system. We encourage health leaders to consider how this role can be sustainably and meaningfully incorporated into the healthcare system.
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Affiliation(s)
- Aisha Lofters
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Vijayshree Prakash
- Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
| | - Kimberly Devotta
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mandana Vahabi
- Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
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12
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Shuldiner J, Shah H, Bar-Ziv S, Mauti J, Kaplan D, Tradrous M, Green ME, Bogoch I, Nowak DA, Mehta K, Desveaux L, Marshall LJ, Ikura S, Taljaard M, Hu J, Vohra-Miller S, Presseau J, Witteman H, Lofters A, Kiran T, Ivers N. Practice Facilitation to Support Family Physicians in Encouraging COVID-19 Vaccine Uptake: A Multimethod Process Evaluation. Ann Fam Med 2023; 21:526-533. [PMID: 38012044 PMCID: PMC10681695 DOI: 10.1370/afm.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/09/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE We offered a practice facilitation intervention to family physicians in Ontario, Canada, known to have large numbers of patients not yet vaccinated against coronavirus disease 2019 (COVID-19). METHODS We conducted a multimethod process evaluation embedded within a randomized controlled trial (clinical trial #NCT05099497). We collected descriptive statistics regarding engagement and qualitative interview data from family physicians and practice facilitators, as well as data from facilitator field notes. We analyzed and triangulated the data using thematic analysis and mapped barriers to and enablers for implementation to structural, organizational, physician, and patient factors. RESULTS Of the 300 approached, 90 family physicians (30%) accepted facilitation. Of these, 57% received technical support to identify unvaccinated patients, 29% used trained medical student volunteers to contact patients on their behalf, and 30% used automated calling to reach patients. Key factors affecting engagement with the intervention were staff shortages owing to COVID-19 (structural), clinic characteristics such as technical issues and gatekeeping by staff, which prevented facilitators from talking with physicians (organizational), burnout (physician), and specialized populations that required targeted resources (patient). The facilitator's ability to address technical issues and connect family physicians with medical students helped with engagement. CONCLUSIONS Strategies to help underresourced family physicians serving high-needs populations for issues of public health importance, such as vaccine promotion, must acknowledge the scarcity of physicians' time and provide new resources. To successfully engage family physicians, practice facilitators should seek to build trust and relationships over time, including with front-office staff.
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Affiliation(s)
- Jennifer Shuldiner
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers);
| | - Huda Shah
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers)
| | - Stacey Bar-Ziv
- Ontario Health, Toronto, Ontario, Canada (Bar-Ziv, Mauti, Kaplan)
| | - Joe Mauti
- Ontario Health, Toronto, Ontario, Canada (Bar-Ziv, Mauti, Kaplan)
| | - David Kaplan
- Ontario Health, Toronto, Ontario, Canada (Bar-Ziv, Mauti, Kaplan)
| | - Mina Tradrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers)
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Tradrous)
| | - Michael E Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada (Green)
| | - Isaac Bogoch
- Department of Medicine, University of Toronto, Toronto General Hospital Research Institute, Toronto, Ontario, Canada (Bogoch)
| | - Dominik Alex Nowak
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (Nowak, Kiran, Ivers)
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Nowak, Vohra-Miller)
| | - Kavita Mehta
- Associations of Family Health Teams of Ontario, Toronto, Ontario, Canada (Mehta)
| | - Laura Desveaux
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers)
- Institute of Better Health, Trillium Health Partners (THP), Mississauga, Ontario, Canada (Desveaux)
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (Desveaux)
| | - Lydia-Joi Marshall
- Health Commons Solution Lab, Sinai Health System, Toronto, Ontario, Canada (Marshall, Ikura)
| | - Sophia Ikura
- Health Commons Solution Lab, Sinai Health System, Toronto, Ontario, Canada (Marshall, Ikura)
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada (Taljaard)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Taljaard, Presseau)
| | - Jia Hu
- Alberta Health Services, Edmonton, Alberta, Canada (Hu)
| | - Sabina Vohra-Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Nowak, Vohra-Miller)
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Taljaard, Presseau)
| | - Holly Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (Witteman)
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada (Lofters)
| | - Tara Kiran
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (Nowak, Kiran, Ivers)
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers)
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (Nowak, Kiran, Ivers)
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13
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O’Neill B, Yusuf A, Lofters A, Huang A, Ekeleme N, Kiran T, Greiver M, Sullivan F, Kurdyak P. Breast Cancer Screening Among Females With and Without Schizophrenia. JAMA Netw Open 2023; 6:e2345530. [PMID: 38019514 PMCID: PMC10687664 DOI: 10.1001/jamanetworkopen.2023.45530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. Objective To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. Design, Setting, and Participants This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures Exposures were schizophrenia and primary care payment models. Main Outcomes and Measures Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. Results The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. Conclusions and Relevance This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.
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Affiliation(s)
- Braden O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | | | - Ngozi Ekeleme
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Frank Sullivan
- School of Medicine, Sir James Mackenzie Institute for Early Diagnosis, Population and Behavioural Science Division, University of St Andrews, St Andrews, Scotland
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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14
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Gagliardi AR, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V. Multi-level strategies to improve equitable timely person-centred osteoarthritis care for diverse women: qualitative interviews with women and healthcare professionals. Int J Equity Health 2023; 22:207. [PMID: 37803475 PMCID: PMC10559457 DOI: 10.1186/s12939-023-02026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. METHODS We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. RESULTS We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. CONCLUSIONS This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Deborah Marshall
- University of Calgary, 2500 University Drive NW, Calgary Alberta T2N1N4, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, 82 Buttonwood Ave, York, M6M2J5, Canada
| | - Cornelia M Borkhoff
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Aisha Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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15
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Manca DP, Fernandes C, Lofters A, Aubrey-Bassler K, Shea-Budgell M, Campbell-Scherer D, Sopcak N, Meaney C, Moineddin R, McBrien K, Krueger P, Wong T, Grunfeld E. Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic. BMC Prim Care 2023; 24:200. [PMID: 37770854 PMCID: PMC10537846 DOI: 10.1186/s12875-023-02159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention. METHODS We tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40-65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. RESULTS Fifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned. The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. CONCLUSIONS We did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. TRIAL REGISTRATION ISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761 .
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Affiliation(s)
- Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
- Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, AB, T6L 5X8, Canada.
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Tracy Wong
- Patient Advisor, Alberta Health Services, Strategic Clinical Networks, Calgary, AB, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
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16
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Bondzi-Simpson A, Ribeiro T, Benipal H, Barabash V, Lofters A, Sutradhar R, Snyder RA, Clarke C, Coburn NG, Hallet J. Integration of the social determinants of health into quality indicators for colorectal cancer surgery: a scoping review protocol. BMJ Open 2023; 13:e075270. [PMID: 37751959 PMCID: PMC10533733 DOI: 10.1136/bmjopen-2023-075270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Quality monitoring is a critical component of high-performing cancer care systems. Quality indicators (QIs) are standardised, evidence-based measures of healthcare quality that allow healthcare systems to track performance, identify gaps in healthcare delivery and inform areas of priority for strategic planning. Social structures and economic systems that allow for unequal access to power and resources that shape health and health inequities can be described through the social determinants of health (SDoH) framework. Therefore, granular analysis of healthcare quality through SDoH frameworks is required to identify patient subgroups who may experience health inequity. Given the high burden of disease of colorectal cancer (CRC) and well-defined cancer care pathways, CRC is often the first disease site targeted by health systems for quality improvement. The objective of this review is to examine how SDoH have been integrated into QIs for CRC surgery. This review aims to address three primary questions: (1) Have SDoH been integrated into the development, reporting and assessment of CRC surgery QIs? (2) When integrated, what measures and statistical methods have been applied? (3) In which direction do individual SDoH influence QIs outputs? METHODS This review will follow Arksey and O'Malley frameworks for scoping reviews. We will search MEDLINE, EMBASE, HealthSTAR databases for papers that examine QIs for CRC surgery applicable to healthcare systems from database inception until January 2023. Interventional trials, prospective and retrospective observational studies, reviews, case series and qualitative study designs will be included. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria. ETHICS & DISSEMINATION No ethics approval is required for this review. Results will be disseminated through scientific presentation and relevant conferences targeted for researchers examining healthcare quality and equity in cancer care. REGISTRATION DETAILS osf.io/vfzd3-Open Science Framework.
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Affiliation(s)
- Adom Bondzi-Simpson
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tiago Ribeiro
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Harsukh Benipal
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Barabash
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Rebecca A Snyder
- Departments of Surgical Oncology and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Callisia Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
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Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
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18
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Abuwa C, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines. BMC Musculoskelet Disord 2023; 24:734. [PMID: 37710195 PMCID: PMC10500823 DOI: 10.1186/s12891-023-06877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. METHODS We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. RESULTS We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. CONCLUSIONS This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. PATIENT OR PUBLIC CONTRIBUTION This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
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Affiliation(s)
- Chidinma Abuwa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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Haward B, Tatar O, Zhu P, Griffin-Mathieu G, McBride E, Waller J, Brotherton J, Lofters A, Mayrand MH, Perez S, Rosberger Z. Are Canadian Women Prepared for the Transition to Primary HPV Testing in Cervical Screening? A National Survey of Knowledge, Attitudes, and Beliefs. Curr Oncol 2023; 30:7055-7072. [PMID: 37504372 PMCID: PMC10378227 DOI: 10.3390/curroncol30070512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
As Canadian provinces and territories prepare to transition to HPV-based primary screening for cervical cancer, failure to identify and address potential barriers to screening could hinder program implementation. We examined screening-eligible Canadians' attitudes towards and knowledge of cervical screening. A nationally representative sample of screening-eligible Canadians (N = 3724) completed a web-based survey in the summer of 2022. Oversampling ensured that half of the sample were underscreened for cervical cancer (>3 years since previous screening or never screened). The participants completed validated scales of cervical cancer, HPV, and HPV test knowledge and HPV test and self-sampling attitudes and beliefs. Between-group differences (underscreened vs. adequately screened) were calculated for scales and items using independent sample t-tests or chi-square tests. The underscreened participants (n = 1871) demonstrated significantly lower knowledge of cervical cancer, HPV, and the HPV test. The adequately screened participants (n = 1853) scored higher on the Confidence and Worries subscales of the HPV Test Attitudes and Beliefs Scale. The underscreened participants scored higher on the Personal Barriers and Social Norms subscales. The underscreened participants also endorsed greater Autonomy conferred by self-sampling. Our findings suggest important differential patterns of knowledge, attitudes, and beliefs between the underscreened and adequately screened Canadians. These findings highlight the need to develop targeted communication strategies and promote patient-centered, tailored approaches in cervical screening programs.
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Affiliation(s)
- Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Emily McBride
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9NH, UK
| | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VI 3010, Australia
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Marie-Hélène Mayrand
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Département d'Obstétrique-Gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Samara Perez
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Departments of Psychology and Psychiatry, McGill University, Montreal, QC H3A 1G1, Canada
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20
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Lofters A, Khalil I, Sopcak N, Shea-Budgell M, Meaney C, Fernandes C, Moineddin R, Campbell-Scherer D, Aubrey-Bassler K, Manca DP, Grunfeld E. Opportunities to improve quality of care for cancer survivors in primary care: findings from the BETTER WISE study. Support Care Cancer 2023; 31:430. [PMID: 37389679 DOI: 10.1007/s00520-023-07883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The BETTER WISE (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care for Wellness of Cancer Survivors and Patients) intervention is an evidence-based approach to prevention and screening for cancers and chronic diseases in primary care that also includes comprehensive follow-up for breast, prostate and colorectal cancer survivors. We describe the process of harmonizing cancer survivorship guidelines to create a BETTER WISE cancer surveillance algorithm and describe both the quantitative and qualitative findings for BETTER WISE participants who were breast, prostate or colorectal cancer survivors. We describe the results in the context of the COVID-19 pandemic. METHODS We reviewed high-quality survivorship guidelines to create a cancer surveillance algorithm. We conducted a cluster randomized trial in three Canadian provinces with two composite index outcome measured 12 months after baseline, and also collected qualitative feedback on the intervention. RESULTS There were 80 cancer survivors for whom we had baseline and follow-up data. Differences between the composite indices in the two study arms were not statistically significant, although a post hoc analysis suggested the COVID-19 pandemic was a key factor in these results. Qualitative finding suggested that participants and stakeholders generally viewed BETTER WISE positively and emphasized the effects of the pandemic. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS BETTER WISE shows promise for providing an evidence-based, patient-centred, comprehensive approach to prevention, screening and cancer surveillance for cancer survivors in the primary care setting. TRIAL REGISTRATION ISRCTN21333761. Registered on December 19, 2016, http://www.isrctn.com/ISRCTN21333761 .
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Affiliation(s)
- Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
| | - Ielaf Khalil
- Sinai Health, 600 University Ave, Toronto, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
- Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, Alberta, T6L 5X8, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
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21
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Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall D, Gagliardi AR. Strategies to Improve Equitable Access to Early Osteoarthritis Diagnosis and Management: An updated Review. Arthritis Care Res (Hoboken) 2023. [PMID: 37382031 DOI: 10.1002/acr.25179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Though osteoarthritis (OA) affects millions of people worldwide, many fail to access recommended early, person-centered OA care, particularly women who are disproportionately impacted by OA. A prior review identified few strategies to improve equitable access to early diagnosis and management for multiple disadvantaged groups. We aimed to update that review with literature published in 2010 or later on strategies to improve OA care for disadvantaged groups including women. We identified only 11 eligible studies, of which only 2 (18%) focused on women only. Other disadvantaged groups targeted in the largely US-based studies included patients who are Black, Spanish-speaking, rural, and adults aged 60 years and older. All studies evaluated interventions targeted to patients; 4 (36%) assessed video decision aids, and 7 (63.6%) assessed in-person, video, or telephone self-management education. Interventions were often multifaceted (n = 9, 82%), and most studies (n = 8, 73%) achieved positive outcomes in at least some outcomes measured. No studies evaluated clinician- or system-level strategies. Few studies (n = 5, 45%) described how they tailored strategies to disadvantaged groups or how they addressed person-centered care concepts apart from enabling self-management. Future research is needed to develop, implement, evaluate, and scale-up multilevel strategies to enhance equitable, person-centered OA care for disadvantaged groups including women.
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Affiliation(s)
- Angela Abenoja
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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22
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Lofters A, Salahub C, Austin PC, Bai L, Berthelot S, Bhatia RS, Desveaux L, Ivers NM, Kiran T, Maclure M, Martin D, McBrien KA, McCracken R, Paterson JM, Rahman B, Shuldiner J, Tadrous M, Thakkar N, Lapointe-Shaw L. Up-to-date on cancer screening among Ontario patients seen by walk-in clinic physicians: A retrospective cohort study. Prev Med 2023; 172:107537. [PMID: 37156431 DOI: 10.1016/j.ypmed.2023.107537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Walk-in clinics are typically viewed as high-volume locations for managing acute issues but also may serve as a location for primary care, including cancer screening, for patients without a family physician. In this population-based cohort study, we compared breast, cervical and colorectal cancer screening up-to-date status for people living in the Canadian province of Ontario who were formally enrolled to a family physician versus those not enrolled but who had at least one encounter with a walk-in clinic physician in the previous year. Using provincial administrative databases, we created two mutually exclusive groups: i) those who were formally enrolled to a family physician, ii) those who were not enrolled but had at least one visit with a walk-in clinic physician from April 1, 2019 to March 31, 2020. We compared up to date status for three cancer screenings as of April 1, 2020 among screen-eligible people. We found that people who were not enrolled and had seen a walk-in clinic physician in the previous year consistently were less likely to be up to date on cancer screening than Ontarians who were formally enrolled with a family physician (46.1% vs. 67.4% for breast, 45.8% vs. 67.4% for cervical, 49.5% vs. 73.1% for colorectal). They were also more likely to be foreign-born and to live in structurally marginalized neighbourhoods. New methods are needed to enable screening for people who are reliant on walk-in clinics and to address the urgent need in Ontario for more primary care providers who deliver comprehensive, longitudinal care.
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Affiliation(s)
- Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada.
| | | | - Peter C Austin
- ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Simon Berthelot
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada
| | - R Sacha Bhatia
- Department of Cardiology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Desveaux
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Better Health at Ontario Trillium Health Partners, Mississauga, Ontario, Canada
| | - Noah M Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Kerry A McBrien
- Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rita McCracken
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - J Michael Paterson
- ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bahram Rahman
- Primary Health Care Branch, Ministry of Health, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Jennifer Shuldiner
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Mina Tadrous
- University Health Network, Toronto, Ontario, Canada; ICES, Ontario, Canada; Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Niels Thakkar
- College of Nurses of Ontario, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- University Health Network, Toronto, Ontario, Canada; ICES, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
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Lapointe-Shaw L, Kiran T, Salahub C, Austin PC, Berthelot S, Desveaux L, Lofters A, Maclure M, Martin D, McBrien KA, McCracken RK, Rahman B, Schultz SE, Shuldiner J, Tadrous M, Bird C, Paterson JM, Bhatia RS, Thakkar NA, Na Y, Ivers NM. Walk-in clinic patient characteristics and utilization patterns in Ontario, Canada: a cross-sectional study. CMAJ Open 2023; 11:E345-E356. [PMID: 37171909 PMCID: PMC10139081 DOI: 10.9778/cmajo.20220095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment. METHODS We performed a cross-sectional study using health administrative data from 2019. We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits. RESULTS Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients' homes than enrolling physicians' offices (0 to < 3 km: 32% v. 22%, SMD 0.21). INTERPRETATION Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. These findings have implications for policy development to improve the integration of walk-in clinics and longitudinal primary care.
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Affiliation(s)
- Lauren Lapointe-Shaw
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont.
| | - Tara Kiran
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Christine Salahub
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Peter C Austin
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Simon Berthelot
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Laura Desveaux
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Aisha Lofters
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Malcolm Maclure
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Danielle Martin
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Kerry A McBrien
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Rita K McCracken
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Bahram Rahman
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Susan E Schultz
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Jennifer Shuldiner
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Mina Tadrous
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Cherryl Bird
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - J Michael Paterson
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - R Sacha Bhatia
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Niels A Thakkar
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Yingbo Na
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
| | - Noah M Ivers
- ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont
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Sayani A, Ali MA, Dey P, Corrado AM, Ziegler C, Nicholson E, Lofters A. Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clin Res Rep 2023; 4:100469. [PMID: 36938372 PMCID: PMC10015251 DOI: 10.1016/j.jtocrr.2023.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Participation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. Methods We conducted a scoping review using the Arksey and O'Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. Results Our search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. Conclusions Interventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.
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Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Corresponding author. Address for correspondence: Ambreen Sayani, MD, PhD, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St., Toronto, ON M5S 1B2, Canada.
| | - Muhanad Ahmed Ali
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Pooja Dey
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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25
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Wang Y, Das RLV, Lapa T, Marosan P, Pawliuk R, Chable HD, Lake D, Lofters A. Career development of international medical graduates in Canada: status of the unmatched. Humanit Soc Sci Commun 2023; 10:38. [PMID: 36741982 PMCID: PMC9885407 DOI: 10.1057/s41599-023-01534-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
With limited residency positions, the majority of international medical graduates living in Canada and other developed countries cannot work as physicians. The educational experience and career development of unmatched international medical graduates (those who are not matched to a residency position) residing in Canada have never been studied. Through an innovative collaboration of provincial international medical graduate organizations, we launched an online survey targeting the career development of unmatched international medical graduates, with 356 survey responses entering data analysis. Respondents reported that at the early career planning stage, close to a third had not had adequate knowledge of their career prospects in Canada. Although official resources are available, most respondents found that the information did not match well with reality. After arriving in Canada, educational resources for unmatched international medical graduates are scarce. The majority of them work in healthcare-related fields but reported significant difficulties finding these positions, and there were limited career training opportunities. Among respondents who were no longer pursuing residency positions and had moved on to alternate career paths, we found, unexpectedly, that 69% of them reported previous residency application experience did not contribute to their current occupation, and most were not satisfied with their current career status and continuing education opportunities. In conclusion, the unmatched international medical graduates could serve as a vital reservoir of skilled medical professionals to serve the community, especially during public health crises. Continuing education and career support of unmatched international medical graduates are crucial for their career development and should be an area of priority for policymakers. Career support, especially for alternative career paths, can be built on the current services that exist in most provinces in Canada. In addition, novel online and social media tools can be utilized to increase the outreach of these programs.
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Affiliation(s)
- Yiming Wang
- Medical Genetics and Genomics Residency Program, University of Toronto, Toronto, ON Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Association of International Physicians and Surgeons of Ontario, Toronto, ON Canada
| | - Rajkumar Luke Vijendra Das
- Association of International Physicians and Surgeons of Ontario, Toronto, ON Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC Canada
| | - Tatiana Lapa
- Association of International Physicians and Surgeons of Ontario, Toronto, ON Canada
| | - Peter Marosan
- Association of International Physicians and Surgeons of Ontario, Toronto, ON Canada
| | - Rosemary Pawliuk
- Society of Canadians Studying Medicine Abroad, Langley, BC Canada
| | - Heidi D. Chable
- Association of International Medical Doctors of British Columbia, Vancouver, BC Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, AB Canada
| | - Aisha Lofters
- Women’s College Hospital, Toronto, ON Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON Canada
- Dana Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Gillis JL, Grennan T, Grewal R, Ogilvie G, Gaspar M, Grace D, Lofters A, Raboud JM, Saarela O, MacPherson P, Rosenes R, Salit IE, Burchell AN, Burchell A, Rueda S, Arbess G, Cohen J, Cooper C, Lavoie E, Crouzat F, Andany N, Walmsley S, Silverman M, Sandre R, Tharao W, Gauvin H, Smaill F. Influence of previous experience with and beliefs regarding anal cancer screening on willingness to be screened among men living with HIV. BMC Public Health 2022; 22:2444. [PMID: 36577960 PMCID: PMC9795733 DOI: 10.1186/s12889-022-14471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/26/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. METHODS We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016-2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men's beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by "anal Pap test"; willingness clustered with positive beliefs (e.g. confident they can get screened; disagree that they will feel pain) in the correspondence analysis. Higher self-perceived risk for anal cancer and positive beliefs regarding screening were associated with higher willingness to be screened. Gay, bisexual and other men who have sex with men had higher willingness (aOR = 1.62; 95% CI: 1.15, 2.29) than heterosexual men. Racialized men reported lower willingness (aOR = 0.68; 95% CI: 0.54, 0.89) than white men. CONCLUSIONS Men generally had positive beliefs and were willing to undergo screening, though there were differences by sexual orientation and racial identity. Tailored community-led initiatives could focus on men's understanding of their risk and expectations of anal cancer screening to facilitate participation.
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Affiliation(s)
- Jennifer L. Gillis
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Troy Grennan
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Ramandip Grewal
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Gina Ogilvie
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Mark Gaspar
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Aisha Lofters
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario Canada
| | - Janet M. Raboud
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Olli Saarela
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Paul MacPherson
- grid.412687.e0000 0000 9606 5108The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Ron Rosenes
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Irving E. Salit
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Ann N. Burchell
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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Ling Y, Cheung MC, Chan KK, Lofters A, Fox C, Patrikar A, Liu N, Singh S. Primary care utilization for patients with newly diagnosed cancer during the COVID-19 pandemic: a population-based study. BMC Cancer 2022; 22:1133. [PMID: 36333707 PMCID: PMC9636629 DOI: 10.1186/s12885-022-10257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic greatly impacted primary care and cancer care. We studied how primary care utilization in Ontario, Canada changed for patients who were newly diagnosed with cancer just prior to the COVID-19 pandemic compared to those diagnosed in non-pandemic years. Methods This population-based, retrospective cohort study used linked healthcare databases to compare outcomes for patients with a new malignancy diagnosed within the year prior to the COVID-19 pandemic, between July 1 and September 30, 2019 (COVID-19 cohort) to those diagnosed in the same months in 2018 and 2017 (pre-pandemic cohort). We used Poisson regression models to compare rates of in-person and virtual visits to patients’ usual primary care physician (PCP), emergency department (ED) visits, and hospitalizations, all reported per person-year of follow-up. Results In-person visits to usual PCPs decreased from 4.07/person-year in the pre-pandemic cohort to 2.58 in the COVID-19 cohort (p < 0.0001). Virtual visits to usual PCPs increased from 0.00 to 1.53 (p < 0.0001). Combined in-person and virtual visits to patients’ usual PCPs was unchanged from 4.07 to 4.12 (p = 0.89). The rate of ED visits decreased from 0.99/person-year to 0.88 (p < 0.0001). Non-elective hospitalizations remained unchanged, from 0.49/person-year to 0.47 (p = 0.1675). Conclusion There was a sizeable shift in primary care visits for cancer patients from in-person to virtual during the pandemic, although there was no resultant increase in hospitalizations. This suggests that early in the pandemic, virtual care allowed for continuity in utilization of primary care, though further studies are required to confirm this persisted later in the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10257-4.
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Affiliation(s)
- Ying Ling
- grid.17063.330000 0001 2157 2938Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Matthew C. Cheung
- grid.17063.330000 0001 2157 2938Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Kelvin K.W. Chan
- grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Canada
| | - Colleen Fox
- Person-Centered Care, Ontario Health, Toronto, Canada
| | | | - Ning Liu
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- grid.413104.30000 0000 9743 1587Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Sayani A, Maybee A, Manthorne J, Nicholson E, Bloch G, Parsons JA, Hwang SW, Shaw JA, Lofters A. Equity-Mobilizing Partnerships in Community (EMPaCT): Co-Designing Patient Engagement to Promote Health Equity. Healthc Q 2022; 24:86-92. [PMID: 35467517 DOI: 10.12927/hcq.2022.26768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Equity-Mobilizing Partnerships in Community (EMPaCT) is a novel approach to patient engagement that centres diverse lived experiences and promotes equity-oriented and inclusive partnerships. As an independent community table, EMPaCT is made up primarily of patients/diverse members of community. Researchers and other decision makers come to this table with their projects to learn how to make their project more inclusive and equitable. In this paper, we detail how we used participatory co-design to define, build and grow EMPaCT as an innovative and scalable patient partnership model that promotes bottom-up action for health equity.
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Affiliation(s)
- Ambreen Sayani
- A Transition to Leadership Stream postdoctoral fellow in Patient-Oriented Research at the Women's College Research Institute at WCH in Toronto, ON, and co-initiator of EMPaCT. Ambreen can be contacted by e-mail at
| | - Alies Maybee
- An independent patient partner, co-initiator of EMPaCT and co-founder of the Patient Advisors Network (PAN) in Toronto, ON
| | - Jackie Manthorne
- The president and chief executive officer of the Canadian Cancer Survivor Network in Toronto, ON
| | - Erika Nicholson
- Vice president, Cancer Control at the Canadian Partnership Against Cancer in Toronto, ON. She works with pan-Canadian partners to drive progress toward the goals of the Canadian Strategy for Cancer Control
| | - Gary Bloch
- A family physician with St. Michael's Hospital and Inner City Health Associates and an associate professor at the University of Toronto in Toronto, ON. His clinical, educational, program development, research and advocacy interests focus on the intersection among primary care, health inequities and the social determinants of health
| | - Janet A Parsons
- A research scientist at the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital and an associate professor with the Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto in Toronto, ON. She is a qualitative methodologist who conducts health services and policy research, with expertise in health and social equity, patient and community engagement and participatory approaches to research and knowledge translation
| | - Stephen W Hwang
- The chair of Homelessness, Housing, and Health; director of the MAP Centre for Urban Health Solutions at St. Michael's Hospital; and a professor of Medicine at the University of Toronto in Toronto, ON
| | - James A Shaw
- An assistant professor in the Department of Physical Therapy at the University of Toronto with cross-appointment to the Institute of Health Policy, Management and Evaluation at the University of Toronto in Toronto, ON. He serves as a research director of Artificial Intelligence (AI), Ethics & Health at the University of Toronto's Joint Centre for Bioethics and is an adjunct scientist at the WCH Institute for Health System Solutions and Virtual Care
| | - Aisha Lofters
- A clinician scientist with the Department of Family and Community Medicine at the University of Toronto and chair in Implementation Science at the Peter Gilgan Centre for Women's Cancers at WCH in Toronto, ON. Her research focuses on cancer screening and prevention with a health equity lens
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Sayani A, Manthorne J, Nicholson E, Bloch G, Parsons JA, Hwang SW, Amenu B, Freedman H, Rathbone M, Jeji T, Wathen N, Browne AJ, Varcoe C, Lofters A. Toward equity-oriented cancer care: a Strategy for Patient-Oriented Research (SPOR) protocol to promote equitable access to lung cancer screening. Res Involv Engagem 2022; 8:11. [PMID: 35382905 PMCID: PMC8980795 DOI: 10.1186/s40900-022-00344-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore, the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening. This can lead to a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. METHODS This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning module for healthcare providers. The learning module will describe the social context of lung cancer risk and promote access to lung cancer screening by increasing equity at the point of care. We have applied the Generative Co-Design Framework for Healthcare Innovation and detail our study processes in three phases and six steps: Pre-design (establishing a study governance structure); Co-design (identifying research priorities, gathering and interpreting data, co-developing module content); and Post-design (pilot testing the module and developing an implementation plan). DISCUSSION Patient engagement in research can promote the design and delivery of healthcare services that are accessible and acceptable to patients. This is particularly important for lung cancer screening as those at highest risk of developing lung cancer are also those who are least likely to participate in lung cancer screening. By detailing the steps of our participatory co-design journey, we are making visible the processes of our work so that they can be linked to future outcomes and related impact, and inform a wide range of patient co-led processes.
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Affiliation(s)
- Ambreen Sayani
- Transition to Leadership Stream Postdoctoral Fellow at the Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | | | | | - Gary Bloch
- St. Michael's Hospital and Inner City Health Associates, University of Toronto, Toronto, Canada
- Wellesley Institute, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Bikila Amenu
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Howard Freedman
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Marlene Rathbone
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Tara Jeji
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Nadine Wathen
- Arthur Labatt Family School of Nursing, Centre for Research on Health Equity and Social Inclusion, Western University, London, Canada
| | - Annette J Browne
- University of British Columbia School of Nursing, Vancouver, BC, Canada
| | - Colleen Varcoe
- University of British Columbia School of Nursing, Vancouver, BC, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Women's College Hospital Family Practice Health Centre, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
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Zelli J, Hum S, Lofters A, Dunn S. Clinician acceptability of self-collected human papillomavirus swabs as a primary cervical cancer screening method. Can Fam Physician 2022; 68:e31-e38. [PMID: 35177513 PMCID: PMC9842175 DOI: 10.46747/cfp.6802e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine knowledge and acceptability of and opinions about human papillomavirus (HPV) self-screening as an alternative to Papanicolaou testing among Canadian primary care providers (PCPs: family physicians and nurse practitioners) and obstetrician-gynecologists (OB-GYNs). DESIGN Descriptive, cross-sectional, anonymous, online pilot survey. SETTING Two academic teaching hospitals in downtown Toronto, Ont. PARTICIPANTS Staff physicians and nurse practitioners in the Department of Family and Community Medicine and the Department of Obstetrics and Gynecology at Women's College Hospital and St Michael's Hospital. MAIN OUTCOME MEASURES Recommended patient groups for, potential advantages and disadvantages of, and likelihood of recommending HPV self-sampling for cervical cancer screening. RESULTS The overall response rate was 30.9%. More than three-quarters of survey respondents were female PCPs. Slightly more than half of clinicians had poor knowledge of HPV self-sampling. However, more than three-quarters would recommend it if there were adequate collection of cervical samples, high patient acceptability, and high sensitivity (almost 100% of respondents), followed by high specificity and cost-effectiveness (more than 80% of respondents). Primary care practitioners were more likely than OB-GYNs to agree that HPV self-sampling made screening easier and less embarrassing for patients. Although not statistically significant, OB-GYNs tended to be more concerned than PCPs were about patients failing to follow up on abnormal HPV results and missed opportunities to address other health issues. CONCLUSION Although knowledge of HPV self-sampling for cervical screening was poor, it was generally acceptable to clinicians if certain screening test conditions were met. However, the potential for missed opportunities to visualize pathology and address other health concerns were raised. These and other clinical practice and health systems issues must be addressed before broad implementation of HPV self-sampling in Canada.
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Affiliation(s)
- Jana Zelli
- Family physician at Dox Medical in Scarborough, Ont
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Ling Y, Chan KK, Patrikar A, Liu N, Lofters A, Fox C, Cheung M, Singh S. Impact of the COVID-19 pandemic on primary care access for patients with gastrointestinal malignancies. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
32 Background: Primary care physicians (PCPs) provide essential support for cancer patients. Both primary and cancer care have been affected by the COVID-19 pandemic. In the US, cancer related encounters and screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al JCO Clin Cancer Inform 2020). However, the impact of the pandemic on primary care access for cancer patients remains unclear. Methods: This was a population-based, retrospective cohort study using administrative healthcare databases held at ICES in Ontario, Canada. Patients with a new gastrointestinal (GI) malignancy diagnosed within the year prior to the pandemic, between July 1 and Sept 30, 2019 (COVID-19 cohort), were compared to patients diagnosed in years unaffected by the pandemic, between July 1 – Sept 30, 2018 and July 1 – Sept 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the pandemic. The primary outcome was number of in-person and telemedicine visits with a PCP. Secondary outcomes were number of in-person and telemedicine visits with a medical oncologist, number of emergency department (ED) visits, and number of unplanned hospitalizations. Outcomes, reported as number of visits per person-year, were compared between the COVID-19 and pre-pandemic cohorts. Results: 2833 individuals diagnosed with a new GI malignancy in the COVID-19 cohort were compared to 5698 individuals in the pre-pandemic cohort. The number of in-person visits to PCPs per person-year significantly decreased from 7.13 [95% CI 7.05 – 7.20] in the pre-pandemic cohort to 4.75 [4.66 – 4.83] in the COVID-19 cohort. Telemedicine visits to PCPs increased from 0.06 [0.05 – 0.07] to 2.07 [2.01 – 2.12]. Combined in-person and telemedicine visits to PCPs decreased from 7.19 [7.11 – 7.26] to 6.82 [6.71 – 6.92]. In-person visits to medical oncologists decreased from 3.73 [3.68 – 3.79] to 2.87 [2.80 – 2.94], and telemedicine visits increased from 0.10 [0.10 – 0.11] to 0.95 [0.91 – 0.99]. Combined in-person and telemedicine visits to medical oncologists remained stable (3.84 [3.78 – 3.89] vs. 3.82 [3.74 – 3.90]). The number of ED visits per person-year decreased from 1.04 [1.01 – 1.07] in the pre-pandemic cohort to 0.93 [0.89 – 0.97] in the COVID-19 cohort. Unplanned hospitalizations did not show a significant change (0.56 [0.54 – 0.58] vs. 0.53 [0.50 – 0.56]). Conclusions: PCP visits for patients with newly diagnosed GI malignancies overall decreased during the pandemic, with a dramatic shift from in-person to telemedicine visits. Visits to medical oncologists also shifted from in-person to telemedicine, but the overall combined visits remained the same. While the number of ED visits decreased, the shift in ambulatory practices did not seem to impact the number of unplanned hospitalizations.
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Affiliation(s)
- Ying Ling
- University of Toronto, Toronto, ON, Canada
| | - Kelvin K. Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Aisha Lofters
- Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Colleen Fox
- Person-Centered Care, Ontario Health, Toronto, ON, Canada
| | - Matthew Cheung
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Simron Singh
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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33
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Ajiboye W, Nelson L, Odhiambo A, Yusuf A, Djiadeu P, Turner DA, Abubakari M, Pedersen C, Brown R, Ni Z, Guillaume G, Lofters A, Williams G. Decision conflict and the decision support needs of HIV PrEP-eligible Black patients in Toronto regarding the adoption of PrEP for HIV prevention. J Int Assoc Provid AIDS Care 2022; 21:23259582211073399. [PMID: 35098770 PMCID: PMC8808024 DOI: 10.1177/23259582211073399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives: This study examined factors contributing to decision conflict and the decision support needs of PrEP-eligible Black patients. Methods:The Ottawa Decision Support Framework (ODSF) was used to guide the development of a key informant guide used for qualitative data collection. Black patients assessed by healthcare providers as meeting the basic criteria for starting PrEP were recruited through the St. Michael's Hospital Academic Family Health Team and clinical and community agencies in Toronto. Participants were interviewed by trained research staff. Qualitative content analysis was guided by the ODSF, and analysis was done using the Nvivo. Results: Four women and twenty-five men (both heterosexual and men who have sex with men) were interviewed. Participants reported having difficulty in decision making regarding adoption of PrEP. The main reasons for decision-conflict regading PrEP adoption were: lack of adequate information about PrEP, concerns about the side effects of PrEP, inability to ascertain the benefits or risk of taking PrEP, provider's lack of adequate time for interaction during clinical consultation, and perceived pressure from healthcare provider. Participants identified detailed information about PrEP, and being able to clarify how their personal values align with the benefits and drawbacks of PrEP as their decision support needs. Conclusion:Many PrEP-eligible Black patients who are prescribed PrEP have decision conflict which often causes delay in decision making and sometimes rejection of PrEP. Healthcare providers should offer decision support to Black patients who are being asked to consider PrEP for HIV prevention.
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Affiliation(s)
- Wale Ajiboye
- St. Michael’s Hospital, Toronto, ON, Canada,Wale Ajiboye, PhD, St. Michael’s Hospital Toronto, ON, Canada.
| | - LaRon Nelson
- St. Michael’s Hospital, Toronto, ON, Canada,Yale School of Nursing, New Haven, CT, USA
| | | | | | | | | | | | | | | | - Zhao Ni
- Yale School of Nursing, New Haven, CT, USA
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Persaud N, Ally M, Woods H, Workentin A, Baxter NN, Boozary A, Grundy Q, Lofters A, McKenzie K, Pinto A, Schünemann HJ, Straus S. Racialised people in clinical guideline panels. Lancet 2022; 399:139-140. [PMID: 34998499 DOI: 10.1016/s0140-6736(21)02759-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Muhamad Ally
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada
| | - Aine Workentin
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada; Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Boozary
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; University Health Network, Toronto, ON, Canada
| | - Quinn Grundy
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Wellesley Institute, Toronto, ON, Canada
| | - Andrew Pinto
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Holger J Schünemann
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1X2, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
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Sayani A, Ali MA, Dey P, Corrado AM, Ziegler C, Sadler A, Williams C, Lofters A. Abstract PO-262: Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Lung cancer screening (LCS) with low-dose CT can reduce mortality due to lung cancer by detecting early-stage tumours that are amenable to treatment. Participation in LCS programs however has not been equally distributed among at-risk groups, such that populations with the highest burden of lung cancer risk (through the social patterning of smoking behaviour) and lowest levels of healthcare utilization (through care which is structurally inaccessible) can experience a widening in healthcare disparities as a result of LCS interventions. Approach: We sought to inform equitable access to LCS by illuminating knowledge and implementation gaps in current interventions designed to increase the uptake of LCS. To do this, we conducted a scoping study using the Arksey and O'Malley methodological framework. We conducted comprehensive searches for lung cancer screening promotion interventions (Ovid Medline, Embase, the Cochrane Library, CINAHL and Scopus) and included published English language peer-reviewed and grey literature published between January 2000 and 2020 that describe an intervention designed to increase the uptake of LDCT lung cancer screening in the Organization for Economic Cooperation and Development (OECD) countries. We extracted data onto a chart modified from the Template for Intervention Description and Republication (TIDieR) checklist and the Consolidated Standards of Reporting Trials. We used the Health Equity Impact Assessment (HEIA) tool to analyse the intended/unintended and positive/negative outcomes of the interventions for populations experiencing the greatest disparities. Results: Our search yielded 2681 articles. We included 22 peer review articles dated from January 2000 to January 2020. Interventions occured primarily in the USA, Europe and Canada. We used the ‘Patient Centered Access to Healthcare' conceptual framework by Khanassov et al 2016 to synthesize our findings. Three main themes summarise current interventions designed to increase the uptake of LCS: (i) a focus on individuals and their ability to engage with the healthcare system; (ii) inadequate targeting of populations experiencing greatest disparities and (iii) a lack of conceptual underpinning in the design of interventions so that the social patterning of lung cancer risk and ability to access care is ignored. Conclusion: LCS interventions must take into consideration the disproportionate burden of lung cancer risk in populations experiencing social disadvantage. Designing interventions that are cognisant of the social distribution of risk and targeted to support the uptake in high-risk populations can prevent an inadvertent widening of health disparities.
Citation Format: Ambreen Sayani, Muhanad Ahmed Ali, Pooja Dey, Ann Marie Corrado, Carolyn Ziegler, Alex Sadler, Christina Williams, Aisha Lofters. Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-262.
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Affiliation(s)
| | | | - Pooja Dey
- 1Women's College Hospital, Toronto, ON, Canada,
| | | | | | - Alex Sadler
- 1Women's College Hospital, Toronto, ON, Canada,
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Kavanagh ME, Chiavaroli L, Glenn AJ, Heijmans G, Grant SM, Chow CM, Josse RG, Malik VS, Watson W, Lofters A, Holmes C, Rackal J, Srichaikul K, Sherifali D, Snelgrove-Clarke E, Udell JA, Juni P, Booth GL, Farkouh ME, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Quality improvement and usability testing of the PortfolioDiet.app, a web-based health application to translate nutrition therapy for cardiovascular risk reduction in primary care (Preprint). JMIR Hum Factors 2021; 9:e34704. [PMID: 35451981 PMCID: PMC9073604 DOI: 10.2196/34704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 12/26/2022] Open
Abstract
Background The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool.
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Affiliation(s)
- Meaghan E Kavanagh
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Genevieve Heijmans
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Shannan M Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
- Departments of Pediatrics and Obstetrics and Gynaecology, IWK Health, Halifax, NS, Canada
- Department of Obstetrics and Gynaecology, Faulty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - William Watson
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Candice Holmes
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Julia Rackal
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kristie Srichaikul
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jacob A Udell
- Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Juni
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gillian L Booth
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Guillaume G, Ramos SR, M'Rabiu Abubakari G, Turner DE, Ajiboye W, Yusuf A, Djiadeu P, Odhiambo AJ, Pedersen C, Lofters A, Williams G, Nelson LE. Barriers and facilitators to providing human immunodeficiency virus pre-exposure prophylaxis decision support to black patients in Canada: a cross-sectional study. Int Health Trends & Persp 2021. [DOI: 10.32920/ihtp.v1i3.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Healthcare settings can build towards a specific social environment, in which Black patients can make informed health decisions, including those about whether or not to use PrEP. We utilize self-determination theory for guidance to identify the extent to which current HIV pre-exposure prophylaxis (PrEP) decision support practices from healthcare professionals (HCP) are autonomy supportive. This identifies future developments and implementations of interventions for HCP capacity building to enhance the autonomy of Black patients who are considering using PrEP. Methods: Using a cross-sectional design for examining HCPs' perspectives on delivering quality PrEP usage-related decision support. Through a cross-sectional online survey of 24 HCP from 10 community-based health centers serving in Toronto, Canada, descriptive statistics were characterized in close-ended survey data and sample. Open-ended survey responses were analyzed using Q- sorting methodology. Results: Of the HCP, 40% were willing to provide PrEP decision support to Black-identified patients. HCP reported barriers of needing education about PrEP and available resources (96%) There’s a need for more education and resources to facilitate decision support for Black patients to improve decision support and reduce PrEP uptake disparities. Conclusion: It is imperative that cultural humility in healthcare is upheld to provide informed decision support since not only health conditions vary from patient to patient, but life experiences and background are equally crucial to the health status of that individual. Competence development among HCP can take the forms of providing training to increase cultural humility awareness, knowledge, and skills that can build towards an environment in which Black patients are informed about and for their health decisions.
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Walsh RL, Lofters A, Moineddin R, Krzyzanowska M, Grunfeld E. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data. Curr Oncol 2021; 28:4786-4804. [PMID: 34898582 PMCID: PMC8628668 DOI: 10.3390/curroncol28060405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.
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Affiliation(s)
- Rachel Lin Walsh
- Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Correspondence:
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Department of Family & Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Monika Krzyzanowska
- Princess Margaret Cancer Centre, Department of Medical Oncology & Hematology, University Health Network, Toronto, ON M5G 2C1, Canada;
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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Nnorom O, Sappong-Kumankumah A, Olaiya OR, Burnett M, Akor N, Shi N, Wright P, Gebreyesus A, Gebremikael L, Lofters A. Afrocentric screening program for breast, colorectal, and cervical cancer among immigrant patients in Ontario. Can Fam Physician 2021; 67:843-849. [PMID: 34772714 DOI: 10.46747/cfp.6711843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PROBLEM ADDRESSED Black and immigrant populations across Canada have lower screening rates than Canadian-born white populations, predisposing them to increased cancer morbidity and mortality. Effective interventions are required to increase cancer screening rates among these populations. OBJECTIVE OF PROGRAM To improve breast, colorectal, and cervical cancer screening rates at TAIBU Community Health Centre, which has a mandate to provide primary health care services to the Black and immigrant community in the greater Toronto area. PROGRAM DESCRIPTION An Afrocentric quality improvement program was developed and implemented, consisting of provider audits, cancer screening education programs, a patient call-back program, and a mammography promotion day. CONCLUSION TAIBU Community Health Centre's continuous quality improvement approach was successful in engaging health care providers and patients to increase cancer screening participation sustainably in a racially and socioeconomically diverse setting. Rates of breast, colorectal, and cervical cancer screening offered to eligible patients increased from 17% to 72%, 18% to 67%, and 59% to 70%, respectively, between 2011 and 2018.
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Affiliation(s)
- Onye Nnorom
- Family physician and Public Health and Preventive Medicine Specialist in Toronto, Ont, Associate Program Director of the Public Health and Preventive Medicine Residency Program at the Dalla Lana School of Public Health, Black Health Theme Lead in the Faculty of Medicine, and Equity, Diversity and Inclusion Lead for the Department of Family and Community Medicine, all at the University of Toronto.
| | | | - Oluwatobi R Olaiya
- Resident in the Michael G. Degroote School of Medicine at McMaster University in Hamilton, Ont
| | - Mervin Burnett
- Research assistant in the Department of Laboratory Medicine and Pathology at the University of Alberta in Edmonton
| | - Nancy Akor
- Registered nurse at TAIBU Community Health Centre (CHC) in Toronto and Coordinator for the Ontario Telemedicine Network
| | - Nan Shi
- Physician assistant in the University Health Network in Toronto
| | | | - Abel Gebreyesus
- Data Management Coordinator at TAIBU CHC and Data Coach (E-QIP) at Addictions and Mental Health Ontario
| | | | - Aisha Lofters
- Family doctor and Chair in Implementation Science at Women's College Hospital, Associate Professor in the Department of Family and Community Medicine at the University of Toronto, Senior Scientist at ICES, and Provincial Primary Care Lead for the Ontario Health (Cancer Care Ontario) Cancer Screening Portfolio
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Sayani A, Lofters A. P61.07 Advancing Health Equity in Cancer Care: The Lived Experiences of Poverty and Access to Lung Cancer Screening. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Eissa A, Lofters A, Akor N, Prescod C, Nnorom O. Augmenter le taux de vaccination contre le SRAS-CoV-2 parmi la population noire au Canada. CMAJ 2021; 193:E1513-E1515. [PMID: 34580149 PMCID: PMC8486474 DOI: 10.1503/cmaj.210949-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Azza Eissa
- Département de médecine familiale et communautaire (Eissa, Lofters, Nnorom) et École de santé publique Dalla Lana (Eissa, Lofters, Nnorom), Université de Toronto; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College; centre de santé communautaire TAIBU (Akor); centre de santé communautaire Black Creek (Prescod), Toronto, Ont.
| | - Aisha Lofters
- Département de médecine familiale et communautaire (Eissa, Lofters, Nnorom) et École de santé publique Dalla Lana (Eissa, Lofters, Nnorom), Université de Toronto; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College; centre de santé communautaire TAIBU (Akor); centre de santé communautaire Black Creek (Prescod), Toronto, Ont
| | - Nancy Akor
- Département de médecine familiale et communautaire (Eissa, Lofters, Nnorom) et École de santé publique Dalla Lana (Eissa, Lofters, Nnorom), Université de Toronto; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College; centre de santé communautaire TAIBU (Akor); centre de santé communautaire Black Creek (Prescod), Toronto, Ont
| | - Cheryl Prescod
- Département de médecine familiale et communautaire (Eissa, Lofters, Nnorom) et École de santé publique Dalla Lana (Eissa, Lofters, Nnorom), Université de Toronto; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College; centre de santé communautaire TAIBU (Akor); centre de santé communautaire Black Creek (Prescod), Toronto, Ont
| | - Onye Nnorom
- Département de médecine familiale et communautaire (Eissa, Lofters, Nnorom) et École de santé publique Dalla Lana (Eissa, Lofters, Nnorom), Université de Toronto; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College; centre de santé communautaire TAIBU (Akor); centre de santé communautaire Black Creek (Prescod), Toronto, Ont
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Sayani A, Maybee A, Manthorne J, Nicholson E, Bloch G, Parsons JA, Hwang SW, Lofters A. Building Equitable Patient Partnerships during the COVID-19 Pandemic: Challenges and Key Considerations for Research and Policy. ACTA ACUST UNITED AC 2021; 17:17-24. [PMID: 34543172 PMCID: PMC8437252 DOI: 10.12927/hcpol.2021.26582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The unequal social and economic burden of the COVID-19 pandemic is evident in racialized and low-income communities across Canada. Importantly, social inequities have not been adequately addressed and current public policies are not reflective of the needs of diverse populations. Public participation in decision-making is crucial and there is, therefore, a pressing need to increase diversity of representation in patient partnerships in order to prevent the further exclusion of socially marginalized groups from research and policy making. Deliberate effort and affirmative action are needed to meaningfully engage and nurture diverse patient partnerships by broadening the scope of the patient community to include excluded or underrepresented individuals or groups. This will help us co-develop ways to enhance access and equity in healthcare and prevent the systematic reproduction of structural inequalities that have already been heightened by the COVID-19 pandemic.
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Affiliation(s)
- Ambreen Sayani
- Transition to Leadership Stream Postdoctoral Fellow, Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Alies Maybee
- Independent Patient Partner and Co-founder, Patient Advisors Network, Toronto, ON
| | - Jackie Manthorne
- President and Chief Executive Officer, Canadian Cancer Survivor Network, Ottawa, ON
| | - Erika Nicholson
- Director, Screening and Atlantic Canada Lead, Canadian Partnership Against Cancer, Toronto, ON
| | - Gary Bloch
- Associate Professor, Department of Family and Community Medicine, University of Toronto; Family Physician, St. Michael's Hospital and Inner City Health Associates; Senior Fellow and AMS Phoenix Fellow, Wellesley Institute, Toronto, ON
| | - Janet A Parsons
- Research Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Associate Professor, Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, ON
| | - Stephen W Hwang
- Professor of Medicine, Department of Medicine, University of Toronto; Director, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON
| | - Aisha Lofters
- Family Physician, Women's College Hospital; Associate Professor and Clinician Scientist, Department of Family and Community Medicine, University of Toronto; Chair in Implementation Science, Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON
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Nadler MB, Ivers N, Marchand-Austin A, Lofters A, Austin PC, Wilson BE, Desnoyers A, Amir E. Patient and provider determinants of breast cancer screening among Ontario women aged 40-49: a population-based retrospective cohort study. Breast Cancer Res Treat 2021; 189:631-640. [PMID: 34414531 DOI: 10.1007/s10549-021-06344-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Canadian breast cancer screening guidelines state that mammography screening for women 40-49 should be individualized based on risk assessment and preferences. This retrospective cohort study describes the frequency of screening in women aged 40-49 and identifies patient and provider-level associations with screening. METHODS Administrative databases were linked. The overall cohort included Ontario women aged 40-49 between April 1, 2009 and March 31, 2019. Subgroups were created: the "screen" group included women who received a mammogram defined as screening (using a set of exclusion criteria) and the "routine screen" group included women with three or more screening mammograms. A multivariable multilevel logistic regression model accounting for patient and provider characteristics was fit to determine characteristics associated with routine screening. The intracluster correlation co-efficient was used to quantify the degree of variation across providers. RESULTS Of approximately 2 million eligible women, there were 532,596 (25.5%) in the screen group and 90,651 (4.3%) the routine screen group. There was an average of 0.30 and 0.52 screening mammograms per woman year, in the screen and routine screen groups, respectively. Routine screening was associated with periodic health exams (OR 1.21, 95% CI 1.20-1.22), receiving pap smears (OR 1.38, 95% CI 1.37-1.39), and fee-for-service models of care (OR 1.32, 95% CI 1.27-1.36). Over 20% of the variation in screening was due to systematic between-provider differences. CONCLUSIONS Approximately 4.3% of women aged 40-49 in Ontario received routine breast cancer screening with substantial variation across providers. Routine screening is associated with periodic health examinations, receipt of pap smears, and fee-for-service models of care.
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Affiliation(s)
- Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Ave, 7-821, Toronto, ON, M5G 1Z5, Canada. .,University of Toronto, Toronto, Canada.
| | - Noah Ivers
- University of Toronto, Toronto, Canada.,ICES, G106, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Aisha Lofters
- University of Toronto, Toronto, Canada.,ICES, G106, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Peter C Austin
- ICES, G106, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brooke E Wilson
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Ave, 7-821, Toronto, ON, M5G 1Z5, Canada.,University of Toronto, Toronto, Canada
| | - Alexandra Desnoyers
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Ave, 7-821, Toronto, ON, M5G 1Z5, Canada.,University of Toronto, Toronto, Canada
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Ave, 7-821, Toronto, ON, M5G 1Z5, Canada.,University of Toronto, Toronto, Canada
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Affiliation(s)
- Azza Eissa
- Department of Family and Community Medicine (Eissa, Lofters, Nnorom) and Dalla Lana School of Public Health (Eissa, Lofters, Nnorom), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; TAIBU Community Health Centre (Akor); Black Creek Community Health Centre (Prescod), Toronto, Ont.
| | - Aisha Lofters
- Department of Family and Community Medicine (Eissa, Lofters, Nnorom) and Dalla Lana School of Public Health (Eissa, Lofters, Nnorom), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; TAIBU Community Health Centre (Akor); Black Creek Community Health Centre (Prescod), Toronto, Ont
| | - Nancy Akor
- Department of Family and Community Medicine (Eissa, Lofters, Nnorom) and Dalla Lana School of Public Health (Eissa, Lofters, Nnorom), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; TAIBU Community Health Centre (Akor); Black Creek Community Health Centre (Prescod), Toronto, Ont
| | - Cheryl Prescod
- Department of Family and Community Medicine (Eissa, Lofters, Nnorom) and Dalla Lana School of Public Health (Eissa, Lofters, Nnorom), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; TAIBU Community Health Centre (Akor); Black Creek Community Health Centre (Prescod), Toronto, Ont
| | - Onye Nnorom
- Department of Family and Community Medicine (Eissa, Lofters, Nnorom) and Dalla Lana School of Public Health (Eissa, Lofters, Nnorom), University of Toronto; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; TAIBU Community Health Centre (Akor); Black Creek Community Health Centre (Prescod), Toronto, Ont
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Erickson A, Habbous S, Wright F, Lofters A, Jerzak K, Das S. THER-01. Targeted therapy and intracranial metastatic disease: a population-based retrospective cohort study. Neurooncol Adv 2021. [PMCID: PMC8351316 DOI: 10.1093/noajnl/vdab071.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Targeted therapies have been hypothesized to prolong survival in the management of patients with intracranial metastatic disease (IMD), but, paradoxically, to increase IMD incidence by improving systemic disease control and prolonging survival from the primary tumor. The real-world benefits of targeted therapy in management of patients with IMD are unclear, as clinical trials have excluded patients with IMD and lacked endpoints reporting intracranial outcomes. Methods This retrospective cohort study included all patients in Ontario, Canada, diagnosed with IMD from 2005 to 2018 with primary diagnoses of breast cancer, lung or bronchus cancer, or melanoma, and control patients matched by primary disease without IMD. Kaplan-Meier and multivariable Cox regression analyses were performed to compare overall survival (OS) between patient sub-cohorts divided by primary disease and stratified by targeted therapy receipt or IMD status. Results Post-IMD targeted therapy was associated with prolonged OS in patients with HER2-positive breast cancer (HR 0.41; 95% CI, 0.33–0.5), EGFR-positive lung cancer (HR 0.28; 95% CI, 0.23–0.34), and BRAF-positive melanoma (HR 0.2; 95% CI, 0.14–0.29), compared to those who did not receive post-IMD targeted therapy. Presence of IMD was associated with shorter OS in patients with metastatic HER2-positive breast cancer (HR 1.8; 95% CI, 1.56–2.08) and metastatic EGFR-positive lung cancer (HR 1.22; 95% CI, 1.08–1.39) but not metastatic BRAF-positive melanoma (HR 1.11; 95% CI, 0.77–1.61), compared to those without IMD. Conclusions Our findings show that real-world use of targeted therapies was associated with prolonged OS in patients with IMD in the setting of HER2-positive breast cancer, EGFR-positive lung cancer, and BRAF-positive melanoma. Inclusion of patients with IMD in clinical trials and use of endpoints that interrogate IMD will be critical to determine the role of targeted therapies in the management of patients with IMD.
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Affiliation(s)
- Anders Erickson
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Frances Wright
- Division of General Surgery, Department of Surgery, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Women’s College Hospital, Toronto, ON, Canada
| | - Katarzyna Jerzak
- Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
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Sayani A, Ali MA, Corrado AM, Ziegler C, Sadler A, Williams C, Lofters A. Interventions designed to increase the uptake of lung cancer screening and implications for priority populations: a scoping review protocol. BMJ Open 2021; 11:e050056. [PMID: 34321305 PMCID: PMC8320256 DOI: 10.1136/bmjopen-2021-050056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND When designing any health intervention, it is important to respond to the unequal determinants of health by prioritising the allocation of resources and tailoring interventions based on the disproportionate burden of illness. This approach, called the targeting of priority populations, can prevent a widening of health inequities, particularly those inequities which can be further widened by differences in the uptake of an intervention. The objective of this scoping review is to describe intervention(s) designed to increase the uptake of lung cancer screening, including the health impact on priority populations and to describe knowledge and implementation gaps to inform the design of equitable lung cancer screening. METHODS We will conduct a scoping review following the methodological framework developed by Arksey and O'Malley. We will conduct comprehensive searches for lung cancer screening promotion interventions in Ovid Medline, Embase, the Cochrane Library, Cumulative Index to Nursing & Allied Health (CINAHL) and Scopus. We will include published English language peer-reviewed and grey literature published between January 2000 and 2020 that describe an intervention designed to increase the uptake of low-dose CT (LDCT) lung cancer screening in the Organization for Economic Cooperation and Development countries. Articles not in English or not describing LDCT will be excluded. Three authors will review retrieved literature in three steps: title, abstract and then full text. Three additional authors will review discrepancies. Authors will extract data from full-text papers into a chart adapted from the Template for Intervention Description and Republication checklist, the Consolidated Standards of Reporting Trials and a Health Equity Impact Assessment tool. Findings will be presented using a narrative synthesis. ETHICS AND DISSEMINATION The knowledge synthesised will be used to inform the equitable design of lung cancer screening and disseminated through conferences, publications and shared with relevant partners. The study does not require research ethics approval as literature is available online.
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Affiliation(s)
- Ambreen Sayani
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Muhanad Ahmed Ali
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Ann Marie Corrado
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Alex Sadler
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Christina Williams
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Aisha Lofters
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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James KA, Everall AC, Cadel L, McCarthy LM, Lofters A, Thompson A, Guilcher SJT. Exploring medication self-management in community-dwelling adults with chronic medication experience: A concept mapping study. Res Social Adm Pharm 2021; 18:2854-2866. [PMID: 34274217 DOI: 10.1016/j.sapharm.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/16/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who take medications often experience challenges including making decisions about risks versus benefits and integrating medication management with all aspects of life (e.g., social and work responsibilities). Existing medication self-management frameworks are primarily adherence-focused and lack integrating holistic perspectives. OBJECTIVE To explore the priorities of people with chronic medication experience (i.e., take at least 1 medication daily for at least 3 months) and what they can contribute to the understanding of medication self-management. METHODS Concept mapping is a participatory, mixed-methods approach with 3 stages: brainstorming, sorting/rating, and mapping. Group brainstorming discussions were held with participants who generated statements about what mattered to them regarding medications in their everyday lives. In sorting/rating, individual participants grouped statements into thematic piles and rated their importance and feasibility. During mapping, a subset of participants discussed and agreed on a visual map and named the statement clusters. Following mapping, the researchers analyzed rating results, stratified by participant characteristics (gender, age, duration of medication use, number of medications, and chronic conditions). RESULTS Sixty-three participants generated 1044 statements during 8 brainstorming sessions, which the researchers synthesized into 94 statements. Fifty-four participants individually sorted and rated the statements. Most statements were rated highly on both importance and feasibility, regardless of participant characteristics. Eight participants attended the mapping session. The final map had 9 thematic clusters, which were named by participants as: 1) researching and becoming educated about medications; 2) social support; 3) effectiveness of medication; 4) self-ownership of medication; 5) ease of use; 6) convenience and accessibility; 7) information provided by healthcare provider; 8) personal interactions with healthcare provider; and 9) patient involvement and trust. CONCLUSIONS Results enhance existing medication management frameworks by providing a more comprehensive perspective. Understanding medication self-management requires more research that incorporates and prioritizes the perspectives of individuals who manage their medications.
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Affiliation(s)
- Kadesha A James
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, Mississauga, ON, L5B 1B8, Canada.
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Clinical and Administrative Building, Mississauga, ON, L5B 1B8, Canada; Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, 5th floor, Toronto, ON, M5G 1V7, Canada.
| | - Aisha Lofters
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, 5th floor, Toronto, ON, M5G 1V7, Canada.
| | - Alison Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Suite 160, Toronto, ON, M5G 1V7, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON, M5T 3M6, Canada.
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Affiliation(s)
- Geetanjali Datta
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Arjumand Siddiqi
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Aisha Lofters
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont
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Janmohamed N, Segal P, Corrado AM, Lofters A, Nguyen P, Townsley C, Zahedi A. Endocrinologist-Perceived Factors Affecting the Transition of Thyroid Cancer Patients from Specialist to Primary Care Postcancer Treatment in Ontario, Canada. Thyroid 2021; 31:895-901. [PMID: 33121388 DOI: 10.1089/thy.2020.0413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Thyroid cancer patient discharge patterns from specialists are heterogeneous, with some specialists following patients for a longer period of time than others. With no well-established transitional plan, such as in breast and colorectal cancer, primary care physicians play a variable role in long-term thyroid cancer care. The objective of this study was to examine endocrinologist-perceived factors affecting the transition of care for thyroid cancer patients through a qualitative and quantitative survey of practicing endocrinologists in Ontario, Canada. Methods: All eligible practicing endocrinologists in Ontario were invited to participate in the study, via an email with an embedded survey link. Consent was assumed if the physician completed the survey. The survey collected physician demographics and asked a series of Likert-scale and open-ended questions on their views regarding transitioning care of their thyroid cancer patients. Quantitative analysis was based on mode and variability. Qualitative analysis was completed using inductive thematic analysis. Results: Seventy physicians completed the survey, with a response rate of 35.5%. Based on the responses to the Likert-scale questions, there was a lack of consensus in terms of discharging criteria for patients who had low-risk papillary thyroid cancer, stable thyrotropin levels, multiple nonthyroid-related comorbidities, and hemithyroidectomy with no disease recurrence. The majority of endocrinologists responded that the main factors affecting discharge included whether the primary care physician was able to follow their recommendations, whether the primary care physician could appropriately adjust levothyroxine doses, and whether the patient was confident that their primary care physician could manage their thyroid cancer follow-up. Themes extracted from the open-ended question also indicated that the main factors affecting the transition of care were related to the primary care physician, the patient, the imaging interpretation, and the discharge guidelines. Conclusion: The lack of consensus among endocrinologists affects the transition of patient care, and there is a need to provide clear and accurate information to primary care physicians and thyroid cancer patients on postcancer treatment care. Efforts should be sought to standardize discharge and long-term care.
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Affiliation(s)
- Neha Janmohamed
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Phillip Segal
- Department of Medicine, University Health Network, Toronto, Canada
| | - Ann Marie Corrado
- The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Aisha Lofters
- Department of Family Practice, The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Patricia Nguyen
- The Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Carol Townsley
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Canada
| | - Afshan Zahedi
- Thyroid Program, Women's College Hospital, Toronto, Canada
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Sayani A, Vahabi M, O’Brien MA, Liu G, Hwang S, Selby P, Nicholson E, Giuliani M, Eng L, Lofters A. Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening. PLoS One 2021; 16:e0251264. [PMID: 33956861 PMCID: PMC8101716 DOI: 10.1371/journal.pone.0251264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. Methods At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens. Results Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how ‘choice’ is contextual to the availability of material resources such as income and housing, and how ‘choice’ is influenced by having access to spaces of care that are free of judgement and personal bias. Conclusion Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.
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Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mary Ann O’Brien
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erika Nicholson
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | | | - Lawson Eng
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
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