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Shapiro GK, Santiago AT, Pittman T, Iwano K, Rodin G, Cole H, Zeman K, Sellmann S, Oza AM, Jones J, Rosenthal M, Conti RM, Rodin D. Disparities in clinical trial enrollment at a Canadian comprehensive cancer center: A 15-year retrospective study. Cancer 2024. [PMID: 38662430 DOI: 10.1002/cncr.35331] [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: 12/01/2023] [Revised: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Disparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center. METHODS Retrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow-up to 2021 (N = 154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area-level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow-up length. RESULTS CT enrollment was 11.2% overall, with a 15-year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78-0.86), ≥65 years (AOR vs. <40, 0.61; 95% CI, 0.56-0.66), non-English speakers (0.72; 95% CI, 0.67-0.77), living ≥250 km away (AOR vs. <15 km, 0.71; 95% CI, 0.62-0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late-stage disease. CONCLUSION Significant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tyler Pittman
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kai Iwano
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather Cole
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Katherine Zeman
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanna Sellmann
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University Questrom School of Business, Boston, Massachusetts, USA
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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2
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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson JL, Lau SCL, Li M, Rodin G. Perspectives of Canadian health leaders on the relationship between medical assistance in dying and palliative and end-of-life care services: a qualitative study. CMAJ 2024; 196:E222-E234. [PMID: 38408784 PMCID: PMC10896594 DOI: 10.1503/cmaj.231241] [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] [Accepted: 12/21/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized in Canada in 2016, but coordination of MAiD and palliative and end-of-life care (PEOLC) services remains underdeveloped. We sought to understand the perspectives of health leaders across Canada on the relationship between MAiD and PEOLC services and to identify opportunities for improved coordination. METHODS In this quantitative study, we purposively sampled health leaders across Canada with expertise in MAiD, PEOLC, or both. We conducted semi-structured interviews between April 2021 and January 2022. Interview transcripts were coded independently by 2 researchers and reconciled to identify key themes using content analysis. We applied the PATH framework for Integrated Health Services to guide data collection and analysis. RESULTS We conducted 36 interviews. Participants expressed diverse views about the optimal relationship between MAiD and PEOLC, and the desirability of integration, separation, or coordination of these services. We identified 11 themes to improve the relationship between the services across 4 PATH levels: client-centred services (e.g., educate public); health operations (e.g., cultivate compassionate and proactive leadership); health systems (e.g., conduct broad and inclusive consultation and planning); and intersectoral initiatives (e.g., provide standard practice guidelines across health care systems). INTERPRETATION Health leaders recognized that cooperation between MAiD and PEOLC services is required for appropriate referrals, care coordination, and patient care. They identified the need for public and provider education, standardized practice guidelines, relationship-building, and leadership. Our findings have implications for MAiD and PEOLC policy development and clinical practice in Canada and other jurisdictions.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
| | - Eryn Tong
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Rinat Nissim
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Camilla Zimmermann
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sara Allin
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Jennifer L Gibson
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sharlane C L Lau
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Madeline Li
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Gary Rodin
- Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
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de Vries FE, Mah K, Malfitano C, Shapiro GK, Zimmermann C, Hales S, Rodin G. Clinical evaluation questionnaire in advanced cancer: a psychometric study of a novel measure of healthcare provider interactions. BMJ Support Palliat Care 2024; 13:e1093-e1102. [PMID: 35172981 DOI: 10.1136/bmjspcare-2021-003408] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The Clinical Evaluation Questionnaire (CEQ) is a patient-reported experience measure (PREM) that assesses the perceived benefit of therapeutic interactions of patients with advanced cancer with their healthcare providers concerning issues relevant to their illness. It was developed for a randomised controlled trial of Managing Cancer and Living Meaningfully (CALM), a brief supportive-expressive therapy for patients with advanced cancer. The present study evaluates the preliminary psychometric properties of the CEQ. METHOD Patients in the CALM and usual care groups completed the CEQ 3 (n=195) and 6 (n=186) months after randomisation. The CEQ's internal consistency, factor structure and concurrent validity were evaluated, and CEQ scores in the treatment groups were compared. RESULTS The CEQ demonstrated high internal consistency for both treatment arms (Cronbach's α=0.94 to 0.95), and a single factor was consistently found in exploratory factor analyses. CEQ scores correlated significantly with satisfaction with the relationship with healthcare providers (r=0.23 to 0.61, p≤0.02) and life completion (r=0.24 to 0.37, p≤0.02) in both groups and with spiritual well-being in the CALM group (meaning: r=0.23 to 0.24, p=0.01 to 0.02; faith: r=0.24 to 0.34, p=0.001 to 0.02). The CALM group showed higher CEQ total scores than usual care at 6 months (CALM: 18.19±6.59; usual care: 14.36±7.67, p<0.001). CONCLUSIONS The CEQ is a reliable and valid PREM of the benefit perceived by patients with advanced cancer from their interactions with healthcare providers. Further study is needed to establish its value as a measure of perceived intervention benefit across different clinical and research settings.
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Affiliation(s)
- Froukje E de Vries
- Department of Psychiatry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
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Koffman J, Shapiro GK, Schulz-Quach C. Enhancing equity and diversity in palliative care clinical practice, research and education. BMC Palliat Care 2023; 22:64. [PMID: 37271813 DOI: 10.1186/s12904-023-01185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023] Open
Abstract
Health disparities in palliative care are preventable consequences of structural discrimination and marginalization. The first step in addressing a problem is recognizing there is one and devotion to fully understanding its multifaceted nature. Palliative care clinicians, educators and researchers must prioritize investigating and mitigating the effects of racial, social, and intersectional injustice.
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Affiliation(s)
- Jonathan Koffman
- Hull York Medical School , Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
| | - Gilla K Shapiro
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Christian Schulz-Quach
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Jivraj N, Shapiro GK, Schulz-Quach C, Van de Laar E, Liu ZA, Weiss J, Croke J. Evaluating Healthcare Professionals' Knowledge, Attitudes, Practices and Education Interest in LGBTQ2 + Cancer Care. J Cancer Educ 2022:10.1007/s13187-022-02244-x. [PMID: 36454364 DOI: 10.1007/s13187-022-02244-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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
The lesbian, gay, bisexual, transgender, queer/questioning and two-spirited, plus (LGBTQ2 +) community experiences cancer-related health disparities and inequities. Our objective was to assess LGBTQ2 + knowledge, attitudes, practices and education interest of healthcare professionals (HCPs), identify opportunities to improve care and inform the development of an HCP education curriculum. This was a mixed methods quality improvement study conducted within a tertiary academic cancer centre. An email was sent to all gynaecologic oncology disease site staff (n = 92) with a secure link to an online survey. We measured respondents' sociodemographic characteristics and LGBTQ2 + knowledge, attitudes, practice behaviours and education interest. Open comments explored HCP experiences and reservations caring for LGBTQ2 + patients and suggestions to improve care. Seventy-five out of ninety-two (82%) HCPs completed the survey, with 7% identifying as LGBTQ2 + . HCPs reported feeling less comfortable (88% vs. 80%, p = 0.031) and knowledgeable (44% vs. 27%, p < 0.001) caring for transgender patients compared to LGBQ2 + patients. Most (76%) were unaware whether LGBTQ2 + -specific patient educational materials existed within their institution. Almost all (92% strongly agreed/agreed) were interested in receiving LGBTQ2 + -specific education. Two themes emerged from analysis of open comments: (i) HCPs are concerned of offending LGBTQ2 + individuals because of their lack of knowledge and (ii) HCPs desire LGBTQ2 + -specific health training, specifically in asking pronouns and caring for transgender patients. HCPs report competency gaps in caring for LGBTQ2 + patients with cancer but desire education. In response, we recommend institutions develop an educational curriculum for HCPs improve communication and inclusivity in cancer care.
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Affiliation(s)
- Nazlin Jivraj
- Gynecology Oncology Ambulatory Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Palliative and End-of-Life Care (GIPPEC), Global Institute of Psychosocial, University of Toronto, Toronto, ON, Canada
| | - Christian Schulz-Quach
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Van de Laar
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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Haward B, Tatar O, Zhu P, Griffin-Mathieu G, Perez S, Shapiro GK, McBride E, Zimet GD, Rosberger Z. Development and validation of the cervical cancer knowledge scale and HPV testing knowledge scale in a sample of Canadian women. Prev Med Rep 2022; 30:102017. [PMID: 36281348 PMCID: PMC9587520 DOI: 10.1016/j.pmedr.2022.102017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022] Open
Abstract
Knowledge of cervical cancer and HPV testing are important factors in proactive and continued engagement with screening and are critical considerations as countries move towards the implementation of HPV-based primary screening programs. However, existing scales measuring knowledge of both cervical cancer and HPV testing are not up to date with the current literature, lack advanced psychometric testing, or have suboptimal psychometric properties. Updated, validated scales are needed to ensure accurate measurement of these factors. Therefore, the aim of this study was to develop and validate two scales measuring cervical cancer knowledge and HPV testing knowledge. A pool of items was generated by retaining relevant existing items identified in a 2019 literature search and developing new items according to themes identified in recent systematic reviews. Items were assessed for relevance by the research team and then refined through seven cognitive interviews with Canadian women. A web-based survey including the remaining items (fourteen for each scale development) was administered to a sample of Canadian women in October and November of 2021. After data cleaning, N = 1027 responses were retained. Exploratory and Confirmatory Factor Analysis were conducted, and Item Response Theory was used to select items. The final cervical cancer knowledge scale (CCKS) and HPV testing knowledge scale (HTKS) were unidimensional, and each consisted of eight items. CFA demonstrated adequate model fit for both scales. The developed scales will be important tools to identify knowledge gaps and inform communications about cervical cancer screening, particularly in the context of HPV-based screening implementation.
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Affiliation(s)
- Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada,Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada,Corresponding author at: Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada.
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Samara Perez
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada,Cedars Cancer Centre, McGill University Health Center (MUHC), Montreal, QC, Canada,Department of Oncology, McGill University, Montreal, QC, Canada
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Emily McBride
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC, Canada,Department of Psychiatry, McGill University, Montreal, QC, Canada,Department of Oncology, McGill University, Montreal, QC, Canada,Department of Psychology, McGill University, Montreal, QC, Canada
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7
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Cheng EY, Mah K, Al-Awamer A, Pope A, Swami N, Wong JL, Mathews J, Howell D, Hannon B, Rodin G, Shapiro GK, Li M, Le LW, Zimmermann C. Public interest in medical assistance in dying and palliative care. BMJ Support Palliat Care 2022; 12:448-456. [PMID: 36171108 DOI: 10.1136/spcare-2022-003910] [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: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Medical assistance in dying (MAiD) is legal in an increasing number of countries, but there are concerns that its availability may compromise access to palliative care. We assessed public interest in MAiD, palliative care, both, or neither, and examined characteristics associated with this interest. METHODS We surveyed a representative sample of the adult Canadian public, accessed through a panel from May to June 2019. Weighted generalised multinomial logistic regression analyses were used to determine characteristics associated with interest in referral to palliative care, MAiD, or both, in the event of diagnosis with a serious illness. RESULTS Of 1362 participants who had heard of palliative care, 611 (44.8% weighted (95% CI 42.1% to 47.5%)) would be interested in both MAiD and palliative care, 322 (23.9% (95% CI 21.5% to 26.2%)) palliative care alone, 171 (12.3% (95% CI 10.5% to 14.1%)) MAiD alone and 258 (19.0% (95% CI 16.9% to 21.2%)) neither. In weighted multinomial logistic regression analyses, interest in both MAiD and palliative care (compared with neither) was associated with better knowledge of the definition of palliative care, older age, female gender, higher education and less religiosity; interest in palliative care alone was associated with better knowledge of the definition of palliative care, older age, female gender and being married/common law; interest in MAiD alone was associated with less religiosity (all p<0.05). CONCLUSIONS There is substantial public interest in potential referral to both MAiD and palliative care. Simultaneous availability of palliative care should be ensured in jurisdictions where MAiD is legal, and education about palliative care should be a public health priority.
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Affiliation(s)
- Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joanne L Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jean Mathews
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Palliative Medicine, Departments of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lisa W Le
- Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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8
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Jivraj N, Shapiro GK, Schulz-Quach C, de Laar EV, Zhiu A, Weiss J, Croke J. Optimizing patient-centered, inclusive care in oncology: Healthcare professionals' knowledge, attitudes, and practices in caring for LGBTQ2+ individuals. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.06.022] [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: 10/15/2022]
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9
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Christou-Ergos M, Wiley KE, Leask J, Shapiro GK. Traumatic Events and Vaccination Decisions: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10060911. [PMID: 35746519 PMCID: PMC9230365 DOI: 10.3390/vaccines10060911] [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: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.
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Affiliation(s)
- Maria Christou-Ergos
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Correspondence:
| | - Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
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10
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Griffin-Mathieu G, Haward B, Tatar O, Zhu P, Perez S, Shapiro GK, McBride E, Thompson EL, Smith LW, Lofters AK, Daley EM, Guichon JR, Waller J, Steben M, Decker KM, Mayrand MH, Brotherton JML, Ogilvie GS, Zimet GD, Norris T, Rosberger Z. Ensuring a successful transition from Pap to HPV-based primary cervical cancer screening in Canada by investigating the psychosocial correlates of women’s intentions: Protocol for an observational study (Preprint). JMIR Res Protoc 2022; 11:e38917. [PMID: 35708742 PMCID: PMC9247817 DOI: 10.2196/38917] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Cedars Cancer Center, McGill University Health Centre, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- HPV Global Action, Montreal, QC, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Emily McBride
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center, Fort Worth, TX, United States
| | | | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Juliet R Guichon
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Marc Steben
- HPV Global Action, Montreal, QC, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cancer Care Manitoba Research Institute, Winnipeg, MB, Canada
| | - Marie-Helene Mayrand
- Research Center, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
- Département d'obstétrique-gynécologie, Université de Montreal, Montreal, QC, Canada
| | - Julia M L Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Population Health, Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Gina S Ogilvie
- BC Cancer Agency, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Women's Hospital, Vancouver, BC, Canada
| | - Gregory D Zimet
- School of Medicine, Indiana University, Bloomington, IN, United States
| | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- HPV Global Action, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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11
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Shapiro GK, Gottfredson N, Leask J, Wiley K, Ganter-Restrepo FE, Jones SP, Menning L, Brewer NT. COVID-19 and missed or delayed vaccination in 26 middle- and high-income countries: An observational survey. Vaccine 2022; 40:945-952. [PMID: 35039193 PMCID: PMC8687753 DOI: 10.1016/j.vaccine.2021.12.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 03/04/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted vaccination services and raised the risk of a global resurgence of preventable diseases. We assessed the extent of and reasons for missed or delayed vaccinations (hereafter 'missed') in middle- and high-income countries in the early months of the pandemic. METHODS From May to June 2020, participants completed an online survey on missed vaccination. Analyses separated missed childhood and adult vaccination in middle-and high-income countries. RESULTS Respondents were 28,429 adults from 26 middle- and high-income countries. Overall, 9% of households had missed a vaccine, and 13% were unsure. More households in middle- than high-income countries reported missed childhood vaccination (7.6% vs. 3.0%) and missed adult vaccination (9.6% vs. 3.4%, both p < .05). Correlates of missed childhood vaccination in middle-income countries included COVID-19 risk factors (respiratory and cardiovascular diseases), younger age, male sex, employment, psychological distress, larger household size, and more children. In high-income countries, correlates of missed childhood vaccination also included immunosuppressive conditions, but did not include sex or household size. Fewer correlates were associated with missed adult vaccination other than COVID-19 risk factors and psychological distress. Common reasons for missed vaccinations were worry about getting COVID-19 at the vaccination clinic (15%) or when leaving the house (11%). Other reasons included no healthcare provider recommendation, clinic closure, and wanting to save services for others. INTERPRETATION Missed vaccination was common and more prevalent in middle- than high-income countries. Missed vaccination could be mitigated by emphasizing COVID-19 safety measures in vaccination clinics, ensuring free and accessible immunization, and clear healthcare provider recommendations.
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Affiliation(s)
- Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada,Corresponding author
| | - Nisha Gottfredson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Julie Leask
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kerrie Wiley
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Sarah P. Jones
- Institute of Global Health Innovation, Imperial College London, St Mary’s Hospital, London, United Kingdom
| | - Lisa Menning
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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12
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Willis E, Mah K, Shapiro GK, Hales S, Li M, An E, Zimmermann C, Schultebraucks K, Rodin G. Testing terror management theory in advanced cancer. Death Stud 2021; 47:1-10. [PMID: 34957923 DOI: 10.1080/07481187.2021.2019145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Death anxiety is common in advanced cancer due to heightened mortality salience. We tested terror management theory (TMT) in this population (N = 305) by evaluating the buffering effect of the distal defenses (attachment security, meaning, self-esteem) on the impact of physical impairment (a proxy for mortality salience) on death anxiety. Patients with greater numbers of strong distal defenses reported lower death anxiety than those with no strong defenses or one strong defense. These findings support the relevance of TMT in individuals facing the actual threat of death and the need for further TMT research in such populations.
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Affiliation(s)
- Elsy Willis
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Data Science Institute, Columbia University, New York, New York, USA
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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13
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Shapiro GK, Tong E, Nissim R, Zimmermann C, Allin S, Gibson J, Li M, Rodin G. Exploring key stakeholders' attitudes and opinions on medical assistance in dying and palliative care in Canada: a qualitative study protocol. BMJ Open 2021; 11:e055789. [PMID: 34862301 PMCID: PMC8646969 DOI: 10.1136/bmjopen-2021-055789] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services. METHODS AND ANALYSIS A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25-30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels. ETHICS AND DISSEMINATION This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Eryn Tong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gibson
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Wiley KE, Levy D, Shapiro GK, Dube E, SteelFisher GK, Sevdalis N, Ganter-Restrepo F, Menning L, Leask J. A user-centered approach to developing a new tool measuring the behavioural and social drivers of vaccination. Vaccine 2021; 39:6283-6290. [PMID: 34538695 DOI: 10.1016/j.vaccine.2021.09.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children around the world remain under-vaccinated for many reasons. To develop effective vaccine delivery programmes and monitor intervention impact, vaccine programme implementers need to understand reasons for under-vaccination within their local context. The World Health Organization (WHO) Working Group on the Behavioural and Social Drivers of Vaccination (BeSD) is developing standardised tools for assessing childhood vaccine acceptance and uptake that can be used across regions and countries. The tools will include: (1) a validated survey; (2) qualitative interview guides; and (3) corresponding user guidance. We report a user-centred needs assessment of key end-users of the BeSD tools. METHODS Twenty qualitative interviews (Apr-Aug 2019) with purposively sampled vaccine programme managers, partners and stakeholders from UNICEF and WHO country and regional offices. The interviews assessed current systems, practices and challenges in data utilisation and reflections on how the BeSD tools might be optimised. Framework analysis was used to code the interviews. RESULTS Regarding current practices, participants described a variety of settings, data systems, and frequencies of vaccination attitude measurement. They reported that the majority of data used is quantitative, and there is appetite for increased use of qualitative data. Capacity for conducting studies on social/behavioural drivers of vaccination was high in some jurisdictions and needed in others. Issues include barriers to collecting such data and variability in sources. Reflecting on the tools, participants described the need to explore the attitudes and practices of healthcare workers in addition to parents and caregivers. Participants were supportive of the proposed mixed-methods structure of the tools and training in their usage, and highlighted the need for balance between tool standardisation and flexibility to adapt locally. CONCLUSIONS A user-centred approach in developing the BeSD tools has given valuable direction to their design, bringing the use of behavioural and social data to the heart of programme planning.
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Affiliation(s)
- K E Wiley
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - D Levy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Australia
| | - G K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Canada
| | - E Dube
- Department of Anthropology, Faculty of Social Sciences, Université Laval, Canada
| | - G K SteelFisher
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, United States
| | - N Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London, UK
| | - F Ganter-Restrepo
- WHO Headquarters Department of Immunization, Vaccines, and Biologicals, Switzerland
| | - L Menning
- WHO Headquarters Department of Immunization, Vaccines, and Biologicals, Switzerland
| | - J Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Australia
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15
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Shapiro GK, Kaufman J, Brewer NT, Wiley K, Menning L, Leask J. A critical review of measures of childhood vaccine confidence. Curr Opin Immunol 2021; 71:34-45. [PMID: 34000455 PMCID: PMC10932019 DOI: 10.1016/j.coi.2021.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 02/15/2021] [Revised: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 01/21/2023]
Abstract
The World Health Organization and global partners sought to identify existing measures of confidence in childhood vaccines, as part of a broader effort to measure the range of behavioural and social drivers of vaccination. We identified 14 confidence measures applicable to childhood vaccination in general, all published between 2010 and 2019. The measures examined 1-5 constructs and included a mean of 12 items. Validation studies commonly examined factor structure, internal consistency reliability, and criterion-related validity. Fewer studies examined convergent and discriminant validity, test-retest reliability, or used cognitive interviewing. Most measures were developed and validated only in high-income countries. These findings highlight the need for a childhood vaccine confidence measure validated for use in diverse global contexts.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Jessica Kaufman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Kerrie Wiley
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lisa Menning
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Julie Leask
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, NSW, Australia
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16
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Li M, Shapiro GK, Klein R, Barbeau A, Rydall A, Bell JAH, Nissim R, Hales S, Zimmermann C, Wong RKS, Rodin G. Medical Assistance in Dying in patients with advanced cancer and their caregivers: a mixed methods longitudinal study protocol. BMC Palliat Care 2021; 20:117. [PMID: 34289838 PMCID: PMC8296526 DOI: 10.1186/s12904-021-00793-4] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The legal criteria for medical assistance in dying (MAiD) for adults with a grievous and irremediable medical condition were established in Canada in 2016. There has been concern that potentially reversible states of depression or demoralization may contribute to the desire for death (DD) and requests for MAiD. However, little is known about the emergence of the DD in patients, its impact on caregivers, and to what extent supportive care interventions affect the DD and requests for MAiD. The present observational study is designed to determine the prevalence, predictors, and experience of the DD, requests for MAiD and MAiD completion in patients with advanced or metastatic cancer and the impact of these outcomes on their primary caregivers. METHODS A cohort of patients with advanced or metastatic solid tumour cancers and their primary caregivers will be recruited from a large tertiary cancer centre in Toronto, Ontario, Canada, to a longitudinal, mixed methods study. Participants will be assessed at baseline for diagnostic information, sociodemographic characteristics, medical history, quality of life, physical and psychological distress, attitudes about the DD and MAiD, communication with physicians, advance care planning, and use of psychosocial and palliative care interventions. Measures will subsequently be completed every six months and at the time of MAiD requests. Quantitative assessments will be supplemented by qualitative interviews in a subset of participants, selected using quota sampling methods. DISCUSSION This study has the potential to add importantly to our understanding of the prevalence and determinants of the DD, MAiD requests and completions in patients with advanced or metastatic cancer and of the experience of both patients and caregivers in this circumstance. The findings from this study may also assist healthcare providers in their conversations about MAiD and the DD with patients and caregivers, inform healthcare providers to ensure appropriate access to MAiD, and guide modifications being considered to broaden MAiD legislation and policy.
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Affiliation(s)
- Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Roberta Klein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Anne Barbeau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Jennifer A. H. Bell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Rebecca K. S. Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
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17
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Shapiro GK, Mah K, Li M, Zimmermann C, Hales S, Rodin G. Validation of the Death and Dying Distress Scale in patients with advanced cancer. Psychooncology 2021; 30:716-727. [PMID: 33368836 DOI: 10.1002/pon.5620] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/24/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Distress about dying and death is an important clinical and research outcome in advanced cancer. A 15-item Death and Dying Distress Scale (DADDS) measure has undergone preliminary validation, but full validation in a large sample has not previously been reported. We investigated its psychometric characteristics and responsiveness to a therapeutic intervention. METHODS This is a secondary analysis of baseline data obtained from a randomized controlled trial of psychotherapeutic intervention for patients with advanced cancer. Participants (n = 386) completed the DADDS, and measures of depression, anxiety, demoralization, quality of life (including preparation for end of life), spirituality, attachment security, and symptom burden. RESULTS A confirmatory factor analysis revealed factors related to "Finitude" and to "Dying." Both factors showed good internal consistency (Cronbach α = 0.861-0.949). DADDS scores were significantly higher in females, those with lower income and not working. Construct validity was demonstrated by a positive correlation between DADDS and demoralization (r = 0.569-0.679), and a negative correlation with preparation for the end of life (r = -0.475 to -0.678). At 6 months, intervention participants with moderate DADDS scores at baseline reported significantly lower DADDS scores on both factors compared to usual care. CONCLUSIONS The DADDS is a valid and brief two-factor measure that assesses distress related to the shortness of time and to the process of dying. The total and factor scores have utility in the clinical and research assessment of death-related distress in patients with advanced cancer.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Shapiro GK, Mah K, de Vries F, Li M, Zimmermann C, Hales S, Rodin G. A cross-sectional gender-sensitive analysis of depressive symptoms in patients with advanced cancer. Palliat Med 2020; 34:1436-1446. [PMID: 32781931 DOI: 10.1177/0269216320947961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with advanced cancer commonly report depressive symptoms. Examinations of gender differences in depressive symptoms in patients with advanced cancer have yielded inconsistent findings. AIM The objective of this study was to investigate whether the severity and correlates of depressive symptoms differ by gender in patients with advanced cancer. DESIGN Participants completed measures assessing sociodemographic and medical characteristics, disease burden, and psychosocial factors. Depressive symptoms were examined using the Patient Health Questionnaire, and other measures included physical functioning, symptom burden, general anxiety, death related distress, and dimensions of demoralization. A cross-sectional analysis examined the univariate and multivariate relationships between gender and depressive symptoms, while controlling for important covariates in multivariate analyses. SETTING/PARTICIPANTS Patients with advanced cancer (N = 305, 40% males and 60% females) were recruited for a psychotherapy trial from outpatient oncology clinics at a comprehensive cancer center in Canada. RESULTS Severity of depressive symptoms was similar for males (M = 7.09, SD = 4.59) and females (M = 7.66, SD = 5.01), t(303) = 1.01, p = 0.314. Greater general anxiety and number of cancer symptoms were associated with depressive symptoms in both males and females. Feeling like a failure (β = 0.192), less death anxiety (β = -0.188), severity of cancer symptoms (β = 0.166), and older age (β = 0.161) were associated with depressive symptoms only in males, while disheartenment (β = 0.216) and worse physical functioning (β = 0.275), were associated with depressive symptoms only in females. CONCLUSIONS Males and females report similar levels of depressive symptoms but the pathways to depression may differ by gender. These differences suggest the potential for gender-based preventive and therapeutic interventions in this population.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Tatar O, Wade K, McBride E, Thompson E, Head KJ, Perez S, Shapiro GK, Waller J, Zimet G, Rosberger Z. Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening. J Womens Health (Larchmt) 2020; 29:390-405. [DOI: 10.1089/jwh.2019.7678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Emily McBride
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Katharine J. Head
- Department of Communication Studies, IU School of Liberal Arts at IUPUI, Indianapolis, Indiana
| | | | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jo Waller
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, Psychiatry and Oncology, McGill University, Montreal, Canada
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20
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Mah K, Shapiro GK, Hales S, Rydall A, Malfitano C, An E, Nissim R, Li M, Zimmermann C, Rodin G. The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psychooncology 2020; 29:833-840. [PMID: 32043679 DOI: 10.1002/pon.5354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/13/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attachment security protects psychological well-being in patients with advanced cancer, but its effect on death preparation in this population has not been demonstrated. We examined the relationship of attachment security to death preparation in advanced cancer and tested whether couple communication mediates this relationship and whether gender and age moderate this mediating effect, using longitudinal data from a psychotherapy trial. METHODS Patients with advanced cancer who lived with a partner (Nbaseline = 289) completed measures of attachment security (attachment avoidance, attachment anxiety), couple communication, and death preparation (preparation for end of life, life completion) and attendant health involvement (relationship with healthcare provider). A moderated mediation model was evaluated at each time period (baseline, 3 months, and 6 months). RESULTS Couple communication mediated the relationship of attachment security to preparation for end of life and life completion (b's = -.06 to -.10). Anxiety × Gender effects on baseline couple communication (P's = .016) indicated that women with greater attachment anxiety reported worse communication than their male counterparts. Couple-communication × Gender × Age effects on baseline preparation for end of life (P = .007-.020) suggested that women showed better preparation with better couple communication. Younger patients reported less preparation than older patients, especially with poorer communication, but their preparation increased with better communication, especially in younger men. CONCLUSIONS Attachment security supports death preparation in advanced cancer partly through better couple communication. Couple-based psychotherapeutic interventions, especially for younger individuals and women with attachment anxiety, may facilitate constructive conversations and death preparation.
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Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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21
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Tatar O, Shapiro GK, Perez S, Wade K, Rosberger Z. Using the precaution adoption process model to clarify human papillomavirus vaccine hesitancy in canadian parents of girls and parents of boys. Hum Vaccin Immunother 2019; 15:1803-1814. [PMID: 30735442 DOI: 10.1080/21645515.2019.1575711] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Achieving optimal human papillomavirus (HPV) vaccine uptake can be delayed by parents' HPV vaccine hesitancy, which is as a multi-stage intention process rather than a dichotomous (vaccinated/not vaccinated) outcome. Our objective was to longitudinally explore HPV related attitudes, beliefs and knowledge and to estimate the effect of psychosocial factors on HPV vaccine acceptability in HPV vaccine hesitant parents of boys and girls. Methods: We used an online survey to collect data from a nationally representative sample of Canadian parents of 9-16 years old boys and girls in September 2016 and July 2017. Informed by the Precaution Adoption Process Model, we categorized HPV vaccine hesitant parents into unengaged/undecided and decided not. Measures included sociodemographics, health behaviors and validated scales for HPV and HPV vaccine related attitudes, beliefs and knowledge. Predictors of HPV vaccine acceptability were assessed with binomial logistic regression. Results: Parents of boys and girls categorized as "flexible" hesitant (i.e., unengaged/undecided) changed over time their HPV related attitudes, behaviors, knowledge and intentions to vaccinate compared to "rigid" hesitant (i.e., decided not) who remained largely unchanged. In "flexible" hesitant, greater social influence to vaccinate (e.g., from family), increased HPV knowledge, higher family income, white ethnicity and lower perception of harms (e.g., vaccine safety), were associated with higher HPV vaccine acceptability. Conclusions: HPV vaccine hesitant parents are not a homogenous group. We have identified significant predictors of HPV vaccine acceptability in "flexible" hesitant parents. Further research is needed to estimate associations between psychosocial factors and vaccine acceptability in "rigid" hesitant parents.
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Affiliation(s)
- Ovidiu Tatar
- a Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal , Quebec , Canada
| | - Gilla K Shapiro
- a Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal , Quebec , Canada.,b Department of Psychology, McGill University , Montreal , Quebec , Canada
| | - Samara Perez
- a Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal , Quebec , Canada.,b Department of Psychology, McGill University , Montreal , Quebec , Canada
| | - Kristina Wade
- a Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal , Quebec , Canada
| | - Zeev Rosberger
- a Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal , Quebec , Canada.,b Department of Psychology, McGill University , Montreal , Quebec , Canada
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22
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Shapiro GK, Tatar O, Amsel R, Prue G, Zimet GD, Knauper B, Rosberger Z. Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons. Prev Med 2018; 116:203-210. [PMID: 30267734 DOI: 10.1016/j.ypmed.2018.09.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 05/02/2018] [Revised: 09/13/2018] [Accepted: 09/22/2018] [Indexed: 12/20/2022]
Abstract
Despite being an effective cancer prevention strategy, human papillomavirus (HPV) vaccination in Canada remain suboptimal. This study is the first to concurrently evaluate HPV vaccine knowledge, attitudes, and the decision-making stage of Canadian parents for their school-aged daughters and sons. Data were collected through an online survey from a nationally representative sample of Canadian parents of 9-16 year old children from August to September 2016. Measures included socio-demographics, validated scales to assess HPV vaccine knowledge and attitudes (using the Health Belief Model), and parents' HPV vaccination adoption stage using the Precaution Adoption Process Model (PAPM; six stages: unaware, unengaged, undecided, decided not, decided to, or vaccinated). 3779 parents' survey responses were analyzed (1826 parents of sons and 1953 parents of daughters). There was a significant association between child's gender and PAPM stage of decision-making, with parents of boys more likely to report being in earlier PAPM stages. In multinomial logistic regression analyses parents of daughters (compared to sons), parents of older children, and parents with a health care provider recommendation had decreased odds of being in any earlier PAPM stage as compared to the last PAPM stage (i.e. vaccinated). Parents who were in the 'decided not to vaccinate' stage had significantly greater odds of reporting perceived vaccine harms, lack of confidence, risks, and vaccine conspiracy beliefs. Future research could use these findings to investigate theoretically informed interventions to specifically target subsets of the population with particular attention towards addressing knowledge gaps, perceived barriers, and concerns of parents.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom of Great Britain and Northern Ireland
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Barbel Knauper
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec H3T 1E4, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
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23
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Tatar O, Thompson E, Naz A, Perez S, Shapiro GK, Wade K, Zimet G, Gilca V, Janda M, Kahn J, Daley E, Rosberger Z. Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis. Prev Med 2018; 116:40-50. [PMID: 30172799 DOI: 10.1016/j.ypmed.2018.08.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/13/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023]
Abstract
Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie, Blvd., EAD 709M, Fort Worth, TX 76107-2699, USA.
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Gilla K Shapiro
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 945 Wolfe Avenue, Québec, Quebec G1V 5B3, Canada.
| | - Monika Janda
- Queensland University of Technology, Faculty of Health, Brisbane, Australia.
| | - Jessica Kahn
- University of Cincinnati (Ohio), Division of Adolescent and Transition Medicine, MLC 4000, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
| | - Ellen Daley
- University of South Florida, Department of Community and Family Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
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Lamanna D, Shapiro GK, Kirst M, Matheson FI, Nakhost A, Stergiopoulos V. Co-responding police-mental health programmes: Service user experiences and outcomes in a large urban centre. Int J Ment Health Nurs 2018; 27:891-900. [PMID: 29044920 DOI: 10.1111/inm.12384] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
As police officers are often the first responders to mental health crises, a number of approaches have emerged to support skilled police crisis responses. One such approach is the police-mental health co-responding team model, whereby mental health nurses and police officers jointly respond to mental health crises in the community. In the present mixed-method study, we evaluated outcomes of co-responding team interactions at a large Canadian urban centre by analysing administrative data for 2743 such interactions, and where comparison data were available, compared them to 16 226 police-only team responses. To understand service user experiences, we recruited 15 service users for in-depth qualitative interviews, and completed inductive thematic analysis. Co-responding team interactions had low rates of injury and arrest, and compared to police-only teams, co-responding teams had higher overall rates of escorts to hospital, but lower rates of involuntary escorts. Co-responding teams also spent less time on hospital handovers than police-only teams. Service users valued responders with mental health knowledge and verbal de-escalation skills, as well as a compassionate, empowering, and non-criminalizing approach. Current findings suggest that co-responding teams could be a useful component of existing crisis-response systems.
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Affiliation(s)
- Denise Lamanna
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Maritt Kirst
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Flora I Matheson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Arash Nakhost
- Mental Health and Addictions Service, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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25
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Merriel SWD, Flannagan C, Kesten JM, Shapiro GK, Nadarzynski T, Prue G. Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men. Int J Environ Res Public Health 2018; 15:E151. [PMID: 29346307 PMCID: PMC5800250 DOI: 10.3390/ijerph15010151] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/22/2022]
Abstract
Men who have sex with men (MSM) may be at higher risk for human papillomavirus (HPV)-associated cancers. Healthcare professionals' recommendations can affect HPV vaccination uptake. Since 2016, MSM up to 45 years have been offered HPV vaccination at genitourinary medicine (GUM) clinics in a pilot programme, and primary care was recommended as a setting for opportunistic vaccination. Vaccination prior to potential exposure to the virus (i.e., sexual debut) is likely to be most efficacious, therefore a focus on young MSM (YMSM) is important. This study aimed to explore and compare the knowledge and attitudes of UK General Practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding HPV vaccination for YMSM (age 16-24). A cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (OR = 0.02, 95% CI = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs.
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Affiliation(s)
- Samuel W D Merriel
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Londonderry BT52 1SA, UK.
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton SO17 1BJ, UK.
| | - Gillian Prue
- School of Nursing and Midwifery, Queens University, Belfast BT7 1NN, UK.
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26
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Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, Perez S, Rosberger Z. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine 2017; 36:660-667. [PMID: 29289384 DOI: 10.1016/j.vaccine.2017.12.043] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [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: 08/24/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The SAGE Working Group on Vaccine Hesitancy developed a vaccine hesitancy measure, the Vaccine Hesitancy Scale (VHS). This scale has the potential to aid in the advancement of research and immunization policy but has not yet been psychometrically evaluated. METHODS Using a cross-sectional design, we collected self-reported survey data from a large national sample of Canadian parents from August to September 2016. An online questionnaire was completed in English or French. We used exploratory and confirmatory factor analysis to identify latent constructs underlying parents' responses to 10 VHS items (response scale 1-5, with higher scores indicating greater hesitancy). In addition to the VHS, measures included socio-demographics items, vaccine attitudes, parents' human papillomavirus (HPV) vaccine decision-making stage, and vaccine refusal. RESULTS A total of 3779 Canadian parents completed the survey in English (74.1%) or French (25.9%). Exploratory and confirmatory factor analysis revealed a two-factor structure best explained the data, consisting of 'lack of confidence' (M = 1.98, SD = 0.72) and 'risks' (M = 3.07, SD = 0.95). Significant Pearson correlations were found between the scales and related vaccine attitudes. ANOVA analyses found significant differences in the VHS sub-scales by parents' vaccine decision-making stages (p < .001). Independent samples t-tests found that the VHS sub-scales were associated with HPV vaccine refusal and refusing another vaccine (p < .001). Socio-demographic differences in the VHS were found; however, effect sizes were small (η2 < 0.02). CONCLUSIONS The VHS was found to have two factors that have construct and criterion validity in identifying vaccine hesitant parents. A limitation of the VHS was few items that loaded on the 'risks' component and a lack of positively and negatively worded items for both components. Based on these results, we suggest modifying the wording of some items and adding items on risk perceptions.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Eve Dube
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada
| | - Barbel Knauper
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Samara Perez
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Québec, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Québec, Canada
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Shapiro GK, Tatar O, Sutton A, Fisher W, Naz A, Perez S, Rosberger Z. Correlates of Tinder Use and Risky Sexual Behaviors in Young Adults. Cyberpsychol Behav Soc Netw 2017; 20:727-734. [PMID: 29211500 DOI: 10.1089/cyber.2017.0279] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tinder is a frequently used geosocial networking application that allows users to meet sexual partners in their geographical vicinity. Research examining Tinder use and its association with behavioral outcomes is scarce. The objectives of this study were to explore the correlates of Tinder use and risky sexual behaviors in young adults. Participants aged 18-26 were invited to complete an anonymous online questionnaire between January and May 2016. Measures included sociodemographic characteristics, Tinder use, health related behaviors, risky sexual behaviors, and sexual attitudes. Associations among these variables were estimated using multivariate logistic regressions. The final sample consisted of 415 participants (n = 166 Tinder users; n = 249 nonusers). Greater likelihood of using Tinder was associated with a higher level of education (OR = 2.18) and greater reported need for sex (OR = 1.64), while decreased likelihood of using Tinder was associated with a higher level of academic achievement (OR = 0.63), lower sexual permissiveness (OR = 0.58), living with parents or relatives (OR = 0.38), and being in a serious relationship (OR = 0.24). Higher odds of reporting nonconsensual sex (OR = 3.22) and having five or more previous sexual partners (OR = 2.81) were found in Tinder users. Tinder use was not significantly associated with condom use. This study describes significant correlates of using Tinder and highlights a relationship between Tinder use with nonconsensual sex and number of previous sexual partners. These findings have salience for aiding public health interventions to effectively design interventions targeted at reducing risky sexual behaviors online.
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Affiliation(s)
- Gilla K Shapiro
- 1 Department of Psychology, McGill University , Montreal, Canada .,2 Lady Davis Institute for Medical Research , Jewish General Hospital, Montreal, Canada
| | - Ovidiu Tatar
- 2 Lady Davis Institute for Medical Research , Jewish General Hospital, Montreal, Canada
| | - Arielle Sutton
- 1 Department of Psychology, McGill University , Montreal, Canada
| | - William Fisher
- 3 Department of Psychology, Western University , London, Canada
| | - Anila Naz
- 2 Lady Davis Institute for Medical Research , Jewish General Hospital, Montreal, Canada
| | - Samara Perez
- 1 Department of Psychology, McGill University , Montreal, Canada .,2 Lady Davis Institute for Medical Research , Jewish General Hospital, Montreal, Canada
| | - Zeev Rosberger
- 1 Department of Psychology, McGill University , Montreal, Canada .,2 Lady Davis Institute for Medical Research , Jewish General Hospital, Montreal, Canada .,4 Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital , Montreal, Canada .,5 Department of Psychiatry and Oncology, McGill University , Montreal, Canada
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Fraiz LD, de Roche A, Mauro C, Catallozzi M, Zimet GD, Shapiro GK, Rosenthal SL. U.S. pregnant women's knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition. Vaccine 2017; 36:165-169. [PMID: 29157958 DOI: 10.1016/j.vaccine.2017.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Zika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women's attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae. METHODS Pregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination. RESULTS Most women (91%) were married/living with the baby's father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated. CONCLUSIONS Pregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.
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Affiliation(s)
- Lauren Dapena Fraiz
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Ariel de Roche
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Christine Mauro
- Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States.
| | - Marina Catallozzi
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, United States.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada; Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd., Ste. 400, Chicago, IL 60612, United States.
| | - Susan L Rosenthal
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
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Tatar O, Perez S, Naz A, Shapiro GK, Rosberger Z. Psychosocial correlates of HPV vaccine acceptability in college males: A cross-sectional exploratory study. Papillomavirus Res 2017; 4:99-107. [PMID: 29179877 PMCID: PMC5883195 DOI: 10.1016/j.pvr.2017.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
Background Most college males are not immunized against the human papillomavirus (HPV) and are at high risk of HPV infection. Most research of correlates of HPV vaccine acceptability in college males has assessed vaccine acceptability as a binary outcome, e.g., vaccinated or not vaccinated, without considering that some students may not even be aware that the HPV vaccine can be given to males. Our objective was to evaluate the psychosocial correlates of HPV acceptability in college males, based on multiple stages of HPV decision-making. Methods We used an online questionnaire to collect data from college men aged 18–26 enrolled at three Canadian universities between September 2013 and April 2014. Vaccine acceptability assessment was informed by the six-stage decision-making Precaution Adoption Process Model (PAPM). We sought information on socio-demographics, health behaviors, HPV vaccine benefits and barriers, worry, susceptibility, severity related to HPV infection and social norms. HPV and HPV vaccine knowledge was measured with validated scales. Psychosocial correlates of HPV vaccine acceptability were assessed with bivariate and multivariate multinomial logistic regression. Actual and perceived HPV and HPV vaccine knowledge scores were calculated. Results The final sample size was 428. Most male college students were unaware that the HPV vaccine could be given to males, unengaged or undecided about getting the HPV vaccine. Significant correlates of higher HPV vaccine acceptability were: increased HPV knowledge, having discussed the HPV vaccine with a healthcare provider, and social norms. Being in an exclusive sexual relationship was significantly associated with lower HPV vaccine acceptability. Students' actual HPV and HPV vaccine knowledge was low and positively correlated to their perception about their HPV knowledge. Conclusions We provided a fine-tuned analysis of psychosocial correlates of HPV vaccine acceptability in college males who are in the early stages of HPV vaccine decision-making. Interventions are needed to increase HPV and HPV vaccine knowledge in college males. Most college males were unaware that the HPV vaccine can be given to males. Significant correlates of HPV vaccine acceptability are provided. Perceived and actual HPV knowledge are positively correlated. The Precaution Adoption Process Model is appropriate for assessing HPV vaccine acceptability.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4.
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4; Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1.
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4.
| | - Gilla K Shapiro
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4; Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4; Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T1E4.
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Shapiro GK, Perez S, Naz A, Tatar O, Guichon JR, Amsel R, Zimet GD, Rosberger Z. Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey. BMJ Open 2017; 7:e017814. [PMID: 29025844 PMCID: PMC5652458 DOI: 10.1136/bmjopen-2017-017814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada's National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. METHODS AND ANALYSIS Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August-September 2016 and June-July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. ETHICS AND DISSEMINATION The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16-219). The study will adopt a multimodal approach to disseminate the study's findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Samara Perez
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Oncology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Shapiro GK, Surian D, Dunn AG, Perry R, Kelaher M. Comparing human papillomavirus vaccine concerns on Twitter: a cross-sectional study of users in Australia, Canada and the UK. BMJ Open 2017; 7:e016869. [PMID: 28982821 PMCID: PMC5640044 DOI: 10.1136/bmjopen-2017-016869] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Opposition to human papillomavirus (HPV) vaccination is common on social media and has the potential to impact vaccine coverage. This study aims to conduct an international comparison of the proportions of tweets about HPV vaccines that express concerns, the types of concerns expressed and the social connections among users posting about HPV vaccines in Australia, Canada and the UK. DESIGN Using a cross-sectional design, an international comparison of English language tweets about HPV vaccines and social connections among Twitter users posting about HPV vaccines between January 2014 and April 2016 was conducted. The Health Belief Model, one of the most widely used theories in health psychology, was used as the basis for coding the types of HPV vaccine concerns expressed on Twitter. SETTING The content of tweets and the social connections between users who posted tweets about HPV vaccines from Australia, Canada and the UK. POPULATION 16 789 Twitter users who posted 43 852 tweets about HPV vaccines. MAIN OUTCOME MEASURES The proportions of tweets expressing concern, the type of concern expressed and the proportions of local and international social connections between users. RESULTS Tweets expressing concerns about HPV vaccines made up 14.9% of tweets in Canada, 19.4% in Australia and 22.6% in the UK. The types of concerns expressed were similar across the three countries, with concerns related to 'perceived barriers' being the most common. Users expressing concerns about HPV vaccines in each of the three countries had a relatively high proportion of international followers also expressing concerns. CONCLUSIONS The proportions and types of HPV vaccine concerns expressed on Twitter were similar across the three countries. Twitter users who mostly expressed concerns about HPV vaccines were better connected to international users who shared their concerns compared with users who did not express concerns about HPV vaccines.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, Canada
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Didi Surian
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam G Dunn
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ryan Perry
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Head Evaluation and Implementation Science, Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Shapiro GK, Guichon J, Kelaher M. Canadian school-based HPV vaccine programs and policy considerations. Vaccine 2017; 35:5700-5707. [DOI: 10.1016/j.vaccine.2017.07.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/28/2022]
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Perez S, Restle H, Naz A, Tatar O, Shapiro GK, Rosberger Z. Parents' involvement in the human papillomavirus vaccination decision for their sons. Sex Reprod Healthc 2017; 14:33-39. [PMID: 29195632 DOI: 10.1016/j.srhc.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/25/2017] [Accepted: 08/23/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Parents are critical to ensure sufficient human papillomavirus (HPV) vaccine coverage. No studies to date have examined how mothers and fathers perceive their own, their partners' and their sons' involvement in HPV vaccination decision-making process. METHODS An online survey methodology was used to collect data from a national sample of Canadian parents (33% fathers, 67% mothers, Mage=44) who had a 9-16years old son (n=3117). MAIN OUTCOME MEASURES Parent's perception of their self-involvement, partner-involvement and son's involvement in the decision to get their son the HPV vaccine were measured on a Likert scale and were classified as 'no involvement', 'moderate involvement' and 'high involvement'. RESULTS Mothers and fathers both perceive that they themselves and their partners should be highly involved in their son's HPV vaccination decision. Son's involvement was reported as moderate and influenced by age. Significant gender differences were found for self and partner involvement, but the effect sizes were small. CONCLUSION Mothers and fathers both perceive that they themselves and their partners should be significantly involved in their son's HPV vaccination decision. A dyad decision-making model involving both parents for HPV vaccine decision-making is suggested with a stronger recommendation for a triad decision-making model involving both parents as well as the child/adolescent. Gender stereotypes of females perceiving themselves as the sole decision-maker or fathers not wanting to be involved in their children's health decision were not supported.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, Montreal, Quebec H3A 1B1, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada.
| | - Hannah Restle
- Department of Psychology, McGill University, Montreal, Quebec H3A 1B1, Canada; Department of Education, Child and School Psychology Program, Hebrew University, Jerusalem, 9190501, Israel
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, Quebec H3A 1B1, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Quebec H3A 1B1, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada; Departments of Oncology and Psychiatry, McGill University, Montreal, Quebec H4A 3T2, Canada
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Perez S, Tatar O, Gilca V, Shapiro GK, Ogilvie G, Guichon J, Naz A, Rosberger Z. Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys. Vaccine 2017; 35:4713-4721. [DOI: 10.1016/j.vaccine.2017.07.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 01/27/2023]
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Shapiro GK, Guichon J, Prue G, Perez S, Rosberger Z. A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada. Prev Med 2017; 100:123-131. [PMID: 28435081 DOI: 10.1016/j.ypmed.2017.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/05/2016] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 12/25/2022]
Abstract
In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Juliet Guichon
- Department of Community Health Sciences, 3280 Hospital Drive, Calgary T2N 4N1, Alberta, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
| | - Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada
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Shapiro GK, Perez S, Rosberger Z. The authors respond to "Supporting the call for a gender-neutral human papillomavirus vaccination in Canada". CMAJ 2017; 189:E119. [PMID: 28246157 DOI: 10.1503/cmaj.732630] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University; and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que
| | - Samara Perez
- Department of Psychology, McGill University; and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que
| | - Zeev Rosberger
- Department of Psychology, McGill University; and Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Que
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Perez S, Tatar O, Shapiro GK, Dubé E, Ogilvie G, Guichon J, Gilca V, Rosberger Z. Psychosocial determinants of parental human papillomavirus (HPV) vaccine decision-making for sons: Methodological challenges and initial results of a pan-Canadian longitudinal study. BMC Public Health 2016; 16:1223. [PMID: 27919239 PMCID: PMC5139028 DOI: 10.1186/s12889-016-3828-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 06/11/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023] Open
Abstract
Background HPV vaccination decision-making is a complex process that is influenced by multiple psychosocial determinants. Given the change in policy recommendation to include males in routine HPV vaccination, our goals were to assess the HPV vaccination uptake in Canada, to understand where Canadian parents were situated in the HPV vaccine decision-making process for their son, how they changed over time and which psychosocial determinants were relevant for this process. Methods We used an online survey methodology and collected data from a nationally representative sample of Canadian parents of boys aged 9–16 at baseline (T1, February 2014) and at 9 months’ follow-up (T2). Our analyses were guided by the Precaution Adoption Process Model (PAPM), a theoretical health behavior model that classifies parents in one of six stages: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate and those who had already vaccinated their sons. Rigorous methods were used to filter out careless responders: response variance, bogus items, psychometric antonyms and psychometric synonyms. Results At T1 and T2, we received 3,784 and 1,608 respectively completed questionnaires; after data cleaning 3,117 (T1) and 1,427 (T2) were retained. Less than 3% of boys were vaccinated at both time points. At both T1 and T2, most parents (over 70%) belonged to the earlier vaccination adoption stages: 57% were unaware (T1) and 15.3% (T2); 20.9% were unengaged (T1) and 32.4% (T2); and 9.1% were undecided (T1) and 25.2% (T2). At follow-up, 37.7% of participants did not move from their initial PAPM decision-making stage. Most parents (55%) preferred to receive information from their healthcare provider (HCP) but only 6% (T1) and 12% (T2) had actually spoken with a HCP about the HPV vaccine for their son. Conclusions HPV vaccination uptake in Canadian boys was very low in the absence of a publicly funded HPV vaccination programs for boys. Optimal HPV information preferences were identified and can be used in interventions to increase HPV knowledge and increase HPV vaccine uptake. Intentions to vaccinate or planning to speak to one’s HCP did not translate into action for most parents over the 9-month follow up; this finding is critical to consider to inform implementation strategies. Methodological challenges are described and suggestions for future research are offered. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3828-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada. .,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, 2400 D'Estimauville, Quebec, G1E 7G9, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, BC Women's Hospital and Health Centre, Room H203G, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Juliet Guichon
- Community Health Sciences, Faculty of Medicine, University of Calgary, 3280 Hospital Drive N.W, Calgary, AB, T2N 4N1, Canada
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 2400 D'Estimauville, Quebec, G1E 7G9, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada.,Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada
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Abstract
In January 2012, the National Advisory Committee on Immunization (NACI) of Canada recommended that males aged 9-26 years receive the human papillomavirus (HPV) vaccine to protect against genital warts and HPV-associated cancers. Estimated HPV vaccine uptake rates for Canadian males are extremely low. Using a content analysis of Canadian newspaper articles, this study investigated what information about the HPV vaccine was relayed to the public, and how this content was portrayed following the 2012 male HPV vaccine recommendation. A search was conducted using Proquest Canadian Newsstand Complete for newspaper articles published between January 1, 2012, and September 1, 2014. Researchers coded 232 articles on several relevant dimensions: article information; epidemiological information; public policy information; article topic; article and title tone; and informant testimony. The majority of articles (93%) mentioned that girls are eligible for the HPV vaccine, whereas only half (49%) mentioned male eligibility. While most articles associated HPV with cervical cancer (85%), fewer indicated its relation to other HPV-associated cancers (59%) or genital warts (52%). Most articles (60%) were positive or neutral (22%) in tone toward the HPV vaccine, while few had mixed messages (11%) or were negative (6%). Less than 5% of articles reported on issues of morality, suggesting that fears that the HPV vaccine causes promiscuity have largely subsided. Notably, article tone toward male vaccination became progressively more positive over time. However, half of the articles did not mention the vaccine's approval for males, and articles tended to report HPV's relation to cervical cancer over other HPV-associated cancers. The Canadian public may thus be unaware of male eligibility and the importance of HPV vaccine for males. The collaboration of researchers, health care providers, and policymakers with journalists is critical in order to disseminate complete and accurate HPV and HPV vaccine information.
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Affiliation(s)
- Samara Perez
- a Department of Psychology , McGill University
- b Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Claire Fedoruk
- a Department of Psychology , McGill University
- b Lady Davis Institute for Medical Research, Jewish General Hospital
- c Department of Anthropology , McGill University
| | - Gilla K Shapiro
- a Department of Psychology , McGill University
- b Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Zeev Rosberger
- a Department of Psychology , McGill University
- b Lady Davis Institute for Medical Research, Jewish General Hospital
- d Department of Psychiatry and Oncology , McGill University
- e Lady Davis Institute for Medical Research and Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital
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Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy beliefs scale. Papillomavirus Res 2016; 2:167-172. [PMID: 29074176 PMCID: PMC5886898 DOI: 10.1016/j.pvr.2016.09.001] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parents' vaccine attitudes influence their decision regarding child vaccination. To date, no study has evaluated the impact of vaccine conspiracy beliefs on human papillomavirus vaccine acceptance. The authors assessed the validity of a Vaccine Conspiracy Beliefs Scale (VCBS) and determined whether this scale was associated with parents' willingness to vaccinate their son with the HPV vaccine. METHODS Canadian parents completed a 24-min online survey in 2014. Measures included socio-demographic variables, HPV knowledge, health care provider recommendation, Conspiracy Mentality Questionnaire (CMQ), the seven-item VCBS, and parents' willingness to vaccinate their son at two price points. RESULTS A total of 1427 Canadian parents completed the survey in English (61.2%) or French (38.8%). A Factor Analysis revealed the VCBS is one-dimensional and has high internal consistency (α=0.937). The construct validity of the VCBS was supported by a moderate relationship with the CMQ (r=0.44, p<0.001). Hierarchical regression analyses found the VCBS is negatively related to parents' willingness to vaccinate their son with the HPV vaccine at both price points ('free' or '$300') after controlling for gender, age, household income, education level, HPV knowledge, and health care provider recommendation. CONCLUSIONS The VCBS is a brief, valid scale that will be useful in further elucidating the correlates of vaccine hesitancy. Future research could use the VCBS to evaluate the impact of vaccine conspiracies beliefs on vaccine uptake and how concerns about vaccination may be challenged and reversed.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4.
| | - Anne Holding
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
| | - Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4
| | - Rhonda Amsel
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
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Perez S, Tatar O, Ostini R, Shapiro GK, Waller J, Zimet G, Rosberger Z. Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys. Prev Med 2016; 91:43-49. [PMID: 27471023 DOI: 10.1016/j.ypmed.2016.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 04/15/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/21/2022]
Abstract
As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, The University of Queensland, West Street, Toowoomba, Qld 4350, Australia
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que.
| | - Samara Perez
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que
| | - Zeev Rosberger
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que
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Abstract
Religion plays a significant role in a patient’s bioethical decision to have an abortion as well as in a country’s abortion policy. Nevertheless, a holistic understanding of the Islamic position remains under-researched. This study first conducted a detailed and systematic analysis of Islam’s position towards abortion through examining the most authoritative biblical texts (i.e. the Quran and Sunnah) as well as other informative factors (i.e. contemporary fatwas, Islamic mysticism and broader Islamic principles, interest groups, and transnational Islamic organizations). Although Islamic jurisprudence does not encourage abortion, there is no direct biblical prohibition. Positions on abortion are notably variable, and many religious scholars permit abortion in particular circumstances during specific stages of gestational development. It is generally agreed that the least blameworthy abortion is when the life of the pregnant woman is threatened and when 120 days have not lapsed; however, there is remarkable heterogeneity in regards to other circumstances (e.g. preserving physical or mental health, foetal impairment, rape, or social or economic reasons), and later gestational development of the foetus. This study secondly conducted a cross-country examination of abortion rights in Muslim-majority countries. A predominantly conservative approach was found whereby 18 of 47 countries do not allow abortion under any circumstances besides saving the life of the pregnant woman. Nevertheless, there was substantial diversity between countries, and 10 countries allowed abortion ‘on request’. Discursive elements that may enable policy development in Muslim-majority countries as well as future research that may enhance the study of abortion rights are discussed. Particularly, more lenient abortion laws may be achieved through disabusing individuals that the most authoritative texts unambiguously oppose abortion, highlighting more lenient interpretations that exist in certain Islamic legal schools, emphasizing significant actors that support abortion, and being mindful of policy frames that will not be well-received in Muslim-majority countries.
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Abstract
There has been some concern among parents and in the media that vaccinating children against human papillomavirus could be seen as giving children permission to engage in risky sexual behaviors (also known as sexual disinhibition). Several studies have found this concern to be unfounded but there have been no attempts to synthesize the relevant studies in order to assess if there is evidence of sexual disinhibition. The aim of this study was to synthesize recent literature examining sexual behaviors and biological outcomes (e.g., sexually transmitted infections) post-HPV vaccination. We reviewed literature from January 1, 2008-June 30, 2015 using PubMed, CINAHL, and Embase with the following search terms: [(sex behavior OR sex behavior OR sexual) AND (human papillomavirus OR HPV) AND (vaccines OR vaccine OR vaccination)] followed by a cited reference search. We included studies that examined biological outcomes and reported behaviors post-vaccination in both males and females. Studies were reviewed by title and abstract and relevant studies were examined as full-text articles. We identified 2,503 articles and 20 were eventually included in the review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors or higher rates of STIs after HPV vaccination. Instead, the studies found that vaccinated compared to unvaccinated individuals were less likely to report vaginal intercourse without a condom (OR = 0.5; 95%CI = 0.4-0.6) and non-use of contraception (OR = 0.27; 95%CI = 0.15-0.48) and unvaccinated participants had higher rates of Chlamydia (OR = 2.3; 95%CI = 1.06-5.00). These results should be reassuring to parents and health care providers.
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Affiliation(s)
- Monica L Kasting
- a Indiana University School of Public Health , Department of Epidemiology , Indianapolis , IN , USA
| | - Gilla K Shapiro
- b Department of Psychology , McGill University , Montreal , QC , Canada.,c Lady Davis Institute for Medical Research & Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital , Montreal , QC , Canada
| | - Zeev Rosberger
- b Department of Psychology , McGill University , Montreal , QC , Canada.,c Lady Davis Institute for Medical Research & Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital , Montreal , QC , Canada
| | - Jessica A Kahn
- d Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Gregory D Zimet
- e Indiana University School of Medicine, Section of Adolescent Medicine , Indianapolis , IN , USA
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Rosberger Z, Perez S, Bloom J, Shapiro GK, Fielding R. The missing piece: cancer prevention within psycho-oncology - a commentary. Psychooncology 2015; 24:1330-1337. [DOI: 10.1002/pon.3916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Zeev Rosberger
- Department of Psychology; McGill University; Montreal QC Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal QC Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center; Jewish General Hospital; Montreal QC Canada
- Departments of Psychiatry and Oncology; McGill University; Montreal QC Canada
| | - Samara Perez
- Department of Psychology; McGill University; Montreal QC Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal QC Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center; Jewish General Hospital; Montreal QC Canada
| | - Joan Bloom
- Kaiser-Permanente Professor of Health Policy and Management and Associate Dean of Students; University of California; Berkeley USA
| | - Gilla K. Shapiro
- Department of Psychology; McGill University; Montreal QC Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal QC Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center; Jewish General Hospital; Montreal QC Canada
| | - Richard Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong
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Perez S, Shapiro GK, Brown CA, Dube E, Ogilvie G, Rosberger Z. 'I didn't even know boys could get the vaccine': Parents' reasons for human papillomavirus (HPV) vaccination decision making for their sons. Psychooncology 2015; 24:1316-1323. [PMID: 26152776 DOI: 10.1002/pon.3894] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study's objective was to examine parents' reasons for their decision to vaccinate their 9-16-year-old sons with the human papillomavirus (HPV) vaccine. METHODS Using the precaution adoption process model (PAPM), parents were classified according to one of six stages of decision making: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate, or vaccinated. Parents responded to an open-ended question: 'What would influence your decision to have your son vaccinated or not against HPV?' RESULTS Three thousand one hundred and seventeen parents provided 2,874 interpretable narrative responses that were coded using thematic content analyses. The majority of parents were in the earlier precaution adoption process model stages, that is, unaware that the HPV vaccine could be given to boys (57.0%), unengaged (20.9%), or undecided (9.1%). Needing more information, vaccine cost, risks associated with vaccination, and wanting a doctor's recommendation influenced these earlier-staged parents' decisions. Parents who decided not to vaccinate their sons (6.8%) reported their decision was due to the risks, insufficient research, lack of confidence in vaccines, and/or no need for the vaccine (as their sons are not sexually active and/or too young). Parents who had decided to vaccinate their sons (5.0%) or who had vaccinated their sons (1.1%) reported that their decisions were based on protecting their sons' health and preventing disease. CONCLUSION There are important differences in the factors that influence parents' decision depending on where they are along the decision-making trajectory. Assuring that parents are well informed about the importance of male vaccination, reducing vaccine cost, accurately communicating vaccine safety, and improving patient-provider communication may augment vaccine coverage and prevent HPV-associated cancers in Canada. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Christopher A Brown
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Eve Dube
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Gina Ogilvie
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada
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Abstract
OBJECTIVE Cannabis is a widely used substance that may be becoming more socially accepted, legally tolerated, and utilized by younger individuals. This review explores the relationship between cannabis and the onset of psychosis as well as the policy ramifications of current research. METHOD This article synthesizes published work that was considered by the author to be relevant to the discussion of cannabis and the onset of psychosis. RESULTS The evidence suggests that, along with other harms, cannabis is a significant risk factor in the etiology of psychosis. Adolescents are more vulnerable to using cannabis, and because of their stage of mental development, the cognitive effects are more pronounced. The mechanism for this change is thought to be neuro-chemical with a stronger effect in those with a diathesis for psychosis. CONCLUSION The risk that cannabis poses to adolescent health should not be neglected. Policy measures should use a multifaceted and strategic perspective in order to prevent adolescents from using this drug.
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Affiliation(s)
- Gilla K Shapiro
- Youthdale Child and Adolescent Sleep Centre, Toronto, ON, Canada.
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Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea syndrome (OSAS). Consistent adherence to CPAP improves the patient's longevity and quality of life as well as public safety. However, nonadherence is a significant contributor to the growing burden of untreated OSAS, and is associated with negative consequences for the patient, public safety, and the healthcare system. OBJECTIVE The use of CPAP is a classic example of an effective treatment for which adherence is extremely variable. This paper examines a multiplicity of factors that influence CPAP adherence. FACTORS These factors are traditionally thought of in terms of patient and equipment variables, but in addition physician, family, healthcare facility, and governmental issues all contribute to CPAP adherence. DISCUSSION These factors are reviewed and pragmatic recommendations are made for improving clinical practice.
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Affiliation(s)
- Gilla K Shapiro
- Youthdale Child and Adolescent Sleep, 227 Victoria St., Lower Level 2, Toronto, ON, M5B 1T8, Canada.
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Shen J, Moller HJ, Wang X, Chung SA, Shapiro GK, Li X, Shapiro CM. Mirtazapine, a sedating antidepressant, and improved driving safety in patients with major depressive disorder: a prospective, randomized trial of 28 patients. J Clin Psychiatry 2009; 70:370-7. [PMID: 19192466 DOI: 10.4088/jcp.08m04234] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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] [Received: 03/20/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objectives of the study were to investigate the effects of mirtazapine, a sedating antidepressant, on driving safety in major depressive disorder (MDD) patients and to observe the effect of mirtazapine on daytime alertness. METHOD Twenty-eight patients who met the DSM-IV criteria for MDD completed the study in a university teaching hospital. Half of these patients took mirtazapine 30 mg at bedtime for 30 days. A computerized driving simulator test (DST) and the Maintenance of Wakefulness Test (MWT) were conducted at baseline and on days 2, 9, 16, and 30 after commencement of antidepressant use. Fourteen untreated depressed patients performed a DST and MWT at baseline and on days 2 and 9 to evaluate the possibility of a learning effect. Data collection was from June 2005 through January 2006. RESULTS There were significant linear effects of the treatment on road position at All Trials (p = .018) and on the morning sessions at 10:00 a.m. (p < .001) and 12:00 p.m. (p = .022) and on the number of crashes at All Trials (p = .034) and the 4:00 p.m. session (p = .050) for the group on active treatment. Compared with the values at baseline, those of road position at 10:00 a.m. significantly improved on days 2 (p < .05), 9 (p < .01), 16 (p < .01) and 30 (p < .01) and road position at 12:00 p.m. significantly improved on days 16 (p < .05) and 30 (p < .05). The number of crashes significantly decreased on day 30 (p < .05). The untreated patients showed no improvement in performance in any of the measures, suggesting that the results are not due to a learning effect. CONCLUSION A sedating antidepressant can increase driving safety in MDD patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00385437.
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Affiliation(s)
- Jianhua Shen
- Sleep Research Unit, Department of Psychiatry, Toronto Western Hospital, Ontario, Canada.
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Ahmadi N, Shapiro GK, Chung SA, Shapiro CM. Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography. Sleep Breath 2008; 13:221-6. [PMID: 19067010 DOI: 10.1007/s11325-008-0234-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [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: 06/22/2008] [Revised: 08/23/2008] [Accepted: 10/23/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate apnea-hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI variability and impact on clinical diagnosis. MATERIALS AND METHODS Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different sleep clinics; the last patient's PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients: four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG. RESULTS Twenty-one percent of the 193 sleep clinic patients had a nightly PSG AHI variability of greater than 5. Forty-eight percent of all patients had a significantly higher AHI on the first night, and 41% had a significantly higher AHI on the second night. Using an AHI > 15 diagnostic criteria, sleep apnea would have been undetected in 20% (n = 39) of patients due to low AHI on one night. Furthermore, 13% of all patients had a more severe sleep apnea classification based on the second night of PSG. For the seven cases, 27-36% of sleep experts failed to identify sleep apnea especially when presented with the PSG containing the lower AHI. Incidences of missed sleep apnea diagnoses were reduced to 15-18% when information from two PSGs was presented to the sleep experts. CONCLUSIONS Utilizing a large patient population, this study supports the significant night-to-night variability in PSG respiratory variables. Identification of sleep apnea in some patients is reduced when sleep experts are provided with only one PSG recording. The clinical implication is that about 13% of sleep clinic patients might benefit from a second night of PSG.
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Affiliation(s)
- Negar Ahmadi
- Sleep Research Unit, Toronto Western Research Institute, University Health Network, ON, Canada.
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