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Parsons Leigh J, FitzGerald EA, Moss SJ, Cherak MS, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin DM, Ahmed SB, MacDonald SE, Straus SE, Manca T, Ng Kamstra J, Soo A, Longmore S, Kupsch S, Sept B, Halperin SA. The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses. Hum Vaccin Immunother 2024; 20:2316417. [PMID: 38390696 PMCID: PMC10896168 DOI: 10.1080/21645515.2024.2316417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | - Michal S Cherak
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Département d'anthropologie, Université Laval, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna M Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terra Manca
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Tricco AC, Parker A, Khan PA, Nincic V, Robson R, MacDonald H, Warren R, Cleary O, Zibrowski E, Baxter N, Burns KEA, Coyle D, Ndjaboue R, Clark JP, Langlois EV, Ahmed SB, Witteman HO, Graham ID, El-Adhami W, Skidmore B, Légaré F, Curran J, Hawker G, Watt J, Bourgeault IL, Leigh JP, Lawford K, Aiken A, McCabe C, Shepperd S, Pattani R, Leon N, Lundine J, Adisso ÉL, Ono S, Rabeneck L, Straus SE. Interventions on gender equity in the workplace: a scoping review. BMC Med 2024; 22:149. [PMID: 38581003 PMCID: PMC10998304 DOI: 10.1186/s12916-024-03346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity). METHODS Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework. RESULTS We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes. CONCLUSIONS There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex. TRIAL REGISTRATION Open Science Framework https://osf.io/x8yae .
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada.
| | - Amanda Parker
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Reid Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Rachel Warren
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Olga Cleary
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ruth Ndjaboue
- École de Travail Social, Université de Sherbrooke, Québec, (Québec), Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Greenway, Australia
| | | | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Karen Lawford
- Department of Gender Studies, Haudenosaunee and Anishinaabek Territories, Queen's University, Settlement of Kingston, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, Canada
| | | | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Reena Pattani
- Department of Medicine, Division of Internal Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Santa Ono
- Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
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Moss SJ, Stelfox M, McArthur E, Sriskandarajah C, Ahmed SB, Birnie K, Halperin DM, Halperin SA, Harley M, Hu J, Kamstra JN, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Social factors associated with self-reported changes in mental health symptoms among youth in the COVID-19 pandemic: a cross-sectional survey. BMC Public Health 2024; 24:631. [PMID: 38413913 PMCID: PMC10900679 DOI: 10.1186/s12889-024-18087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Children and youth experienced marked impacts on day-to-day life in the COVID-19 pandemic that were associated with poorer familial and friend relationships, and greater mental health challenges. Few studies provide self-report data on mental health symptoms from children and youth themselves. We sought to examine the associations between social factors and child and youth self-reported symptoms of worsened mood, anxiety, and irritability during the COVID-19 pandemic. METHODS A nationally representative cross-sectional survey was administered online to collect self-report data across 10 Canadian provinces among children (11-14 years) and youth (15-18 years), April-May 2022. Age-appropriate questions were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. Associations between a priori defined social factors (e.g., relationship quality) and respondent self-reported mental health were evaluated using ordinal logistic regression models adjusted for age, sex, and geographic location. RESULTS We analyzed data from 483 (51.7%) children (11-14 years; 227, 47.0% girls) and 450 (48.3%) youth (15-18 years; 204, 45.3% girls). The parents of most children and youth had resided in Canada for over 20 years (678, 72.7%). Over one-quarter of children and youth self-identified as Black, Indigenous, or a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to pre-pandemic. In descending order of odds ratios (OR), for children and youth, worsened familial relationships (during compared to pre-pandemic) was associated with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 2.51-6.88; youth: OR 6.65 95%CI 3.98-11.23), anxiety (child: OR 4.24, 95%CI2.69-6.75; youth: OR 5.28, 95%CI 3.17-8.86), and irritability (child: OR 2.83, 95%CI 1.76-4.56; youth: OR 6.46, 95%CI 3.88-10.90). CONCLUSIONS Self-reported data from a nationally representative sample of children and youth suggest strong associations between social factors and mental health during the COVID-19 pandemic. Interventions targeting child and youth familial relationships may positively impact child and youth mental health.
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Affiliation(s)
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna M Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Leigh JP, FitzGerald EA, Moss SJ, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin D, Ahmed SB, MacDonald SE, Straus SE, Manca T, Kamstra JN, Soo A, Longmore S, Kupsch S, Sept B, Halperin S. Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey. Can J Public Health 2024; 115:26-39. [PMID: 37991692 PMCID: PMC10853155 DOI: 10.17269/s41997-023-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE COVID-19 transmission, emergence of variants of concern, and weakened immunity have led to recommended vaccine booster doses for COVID-19. Vaccine hesitancy challenges broad immunization coverage. We deployed a cross-national survey to investigate knowledge, beliefs, and behaviours toward continued COVID-19 vaccination. METHODS We administered a national, cross-sectional online survey among adults in Canada between March 16 and March 26, 2022. We utilized descriptive statistics to summarize our sample, and tested for demographic differences, perceptions of vaccine effectiveness, recommended doses, and trust in decisions, using the Rao-Scott correction for weighted chi-squared tests. Multivariable logistic regression was adjusted for relevant covariates to identify sociodemographic factors and beliefs associated with vaccine hesitancy. RESULTS We collected 2202 completed questionnaires. Lower education status (high school: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.29, 2.81) and having children (OR 1.89, CI 1.39, 2.57) were associated with increased odds of experiencing hesitancy toward a booster dose, while higher income ($100,000-$149,999: OR 0.60, CI 0.39, 0.91; $150,000 or more: OR 0.49, CI 0.29, 0.82) was associated with decreased odds. Disbelief in vaccine effectiveness (against infection: OR 3.69, CI 1.98, 6.90; serious illness: OR 3.15, CI 1.69, 5.86), disagreeing with government decision-making (somewhat disagree: OR 2.70, CI 1.38, 5.29; strongly disagree: OR 4.62, CI 2.20, 9.7), and beliefs in over-vaccinating (OR 2.07, CI 1.53, 2.80) were found associated with booster dose hesitancy. CONCLUSION COVID-19 vaccine hesitancy may develop or increase regarding subsequent vaccines. Our findings indicate factors to consider when targeting vaccine-hesitant populations.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
- Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada.
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Stephana J Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Sofia B Ahmed
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Josh Ng Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Jaworska N, Krewulak KD, Schalm E, Niven DJ, Ismail Z, Burry LD, Leigh JP, Fiest KM. Facilitators and Barriers Influencing Antipsychotic Medication Prescribing and Deprescribing Practices in Critically Ill Adult Patients: a Qualitative Study. J Gen Intern Med 2023; 38:2262-2271. [PMID: 37072535 PMCID: PMC10112822 DOI: 10.1007/s11606-023-08042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/13/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Antipsychotic medications do not alter the incidence or duration of delirium, but these medications are frequently prescribed and continued at transitions of care in critically ill patients when they may no longer be necessary or appropriate. OBJECTIVE The purpose of this study was to identify and describe relevant domains and constructs that influence antipsychotic medication prescribing and deprescribing practices among physicians, nurses, and pharmacists that care for critically ill adult patients during and following critical illness. DESIGN We conducted qualitative semi-structured interviews with critical care and ward healthcare professionals including physicians, nurses, and pharmacists to understand antipsychotic prescribing and deprescribing practices for critically ill adult patients during and following critical illness. PARTICIPANTS Twenty-one interviews were conducted with 11 physicians, five nurses, and five pharmacists from predominantly academic centres in Alberta, Canada, between July 6 and October 29, 2021. MAIN MEASURES We used deductive thematic analysis using the Theoretical Domains Framework (TDF) to identify and describe constructs within relevant domains. KEY RESULTS Seven TDF domains were identified as relevant from the analysis: Social/Professional role and identity; Beliefs about capabilities; Reinforcement; Motivations and goals; Memory, attention, and decision processes; Environmental context and resources; and Beliefs about consequences. Participants reported antipsychotic prescribing for multiple indications beyond delirium and agitation including patient and staff safety, sleep management, and environmental factors such as staff availability and workload. Participants identified potential antipsychotic deprescribing strategies to reduce ongoing antipsychotic medication prescriptions for critically ill patients including direct communication tools between prescribers at transitions of care. CONCLUSIONS Critical care and ward healthcare professionals report several factors influencing established antipsychotic medication prescribing practices. These factors aim to maintain patient and staff safety to facilitate the provision of care to patients with delirium and agitation limiting adherence to current guideline recommendations.
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Affiliation(s)
- Natalia Jaworska
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Emma Schalm
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Lisa D Burry
- Departments of Pharmacy and Medicine, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Gallant AJ, Steenbeek A, Halperin SA, Parsons Leigh J, Curran JA. Identifying and addressing the impacts of the COVID-19 pandemic on school-based immunisation programmes in the Canadian Maritimes: a mixed methods study protocol. BMJ Open 2023; 13:e073172. [PMID: 37369397 PMCID: PMC10410997 DOI: 10.1136/bmjopen-2023-073172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic highlighted the importance of keeping up to date on routine vaccinations. Throughout the pandemic, many routine vaccine programmes in Canada were paused or cancelled, including school-based immunisation programmes (SBIP). This resulted in decreased coverage for many vaccine-preventable diseases. While the effects of the pandemic on SBIP have been described in other provinces, its effects in the Maritime region (ie, Nova Scotia, New Brunswick and Prince Edward Island) have yet to be understood. We aim to determine how these programmes were affected by COVID-19 and associated public health measures in the Canadian Maritimes by (1) identifying and describing usual and interim catch-up programmes; (2) exploring stakeholders' perceptions of SBIP through interviews; and (3) designing recommendations with stakeholders to address gaps in SBIP and vaccine coverage. METHODS AND ANALYSIS A sequential, explanatory mixed methods study design will be used to address the objectives during the study period (September 2022-December 2023). First, an environmental scan will describe changes to SBIP and vaccine coverage over a period of five school years (2018/2019-2022/2023). Findings will inform semistructured interviews (n=65) with key stakeholders (eg, health officials, healthcare providers, school officials and parents and adolescents) to explore perceptions of SBIP and changes in parental vaccine hesitancy during the pandemic. These data will be integrated to design recommendations to support SBIP during two stakeholder engagement meetings. Analysis will be guided by the behaviour change wheel, a series of complementary tools and frameworks to simplify behaviour diagnosis and analysis in public health research. ETHICS AND DISSEMINATION Ethics approval for this study has been obtained from Dalhousie University's Health Sciences Research Ethics Board (Ref: 2022-6395). Informed consent will be obtained from participants prior to participating in an interview or stakeholder engagement meeting. Study findings will be disseminated through conference presentations, publications and infographics.
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Affiliation(s)
- Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Audrey Steenbeek
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
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Moss SJ, Racine N, Ahmed S, Birnie K, Cherak MS, Curran JA, Halperin D, Halperin SA, Harley M, Hu J, Leppan L, Nickel A, Russell K, Solis M, Smith S, Soo A, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Codesigning a user-centred digital psychoeducational tool for youth mental well-being with families in Canada: study protocol for a sequential exploratory mixed methods study. BMJ Open 2023; 13:e072533. [PMID: 37369410 PMCID: PMC10410808 DOI: 10.1136/bmjopen-2023-072533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION On 11 March 2020, WHO declared the novel coronavirus (COVID-19) disease a global pandemic. Governments globally implemented physical distancing measures and closure of public institutions that resulted in varying implications to youth mental well-being (eg, social isolation, reduced extracurricular activities). These impacts may have detrimental short-term and long-term effects on youth mental well-being; care for youth with mental health disorders was already overstretched, underfunded and fragmented before the pandemic and youth are not often considered in mental health initiatives. There is a pressing need to partner with youth and families to target and improve youth mental well-being prior to the onset of a mental health disorder, as well as to conduct research on youth mental well-being needs related to pandemic recovery. Here we present a protocol for partnering with youth and families to codesign a user-centred digital tool for youth mental well-being. METHODS AND ANALYSIS We will conduct a national research study to develop a catalogue of recommendations specific to supporting youth mental well-being, and a digital tool to support youth mental well-being through three phases of work: (1) expert consultation on data related to supporting youth mental well-being existing within our Pandemic Preparedness Research Program; (2) codesign of an innovative digital tool for youth mental well-being; and (3) assessment of the tool's usability and acceptability. ETHICS AND DISSEMINATION This study has been approved by the Dalhousie Research Ethics Board (2023-6538) and the Conjoint Health Research Ethics Board (23-0039). This study will complement ongoing foundational research in youth conducted by our team that involves partnering with youth and families to understand the unique implications of the pandemic on this population.
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Affiliation(s)
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sofia Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Birnie
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michal S Cherak
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna Halperin
- School of Nursing, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Scott A Halperin
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Micaela Harley
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jia Hu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristine Russell
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacie Smith
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Soo
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kirsten M Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leigh JP, Moss SJ, Sriskandarajah C, McArthur E, Ahmed SB, Birnie K, Halperin D, Halperin S, Harley M, Hu J, Ng Kamstra J, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM. A muti-informant national survey on the impact of COVID-19 on mental health symptoms of parent-child dyads in Canada. Sci Rep 2023; 13:7972. [PMID: 37198202 DOI: 10.1038/s41598-023-34544-7] [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: 01/12/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
The COVID-19 pandemic negatively impacted the mental health of children, youth, and their families which must be addressed and prevented in future public health crises. Our objective was to measure how self-reported mental health symptoms of children/youth and their parents evolved during COVID-19 and to identify associated factors for children/youth and their parents including sources accessed for information on mental health. We conducted a nationally representative, multi-informant cross-sectional survey administered online to collect data from April to May 2022 across 10 Canadian provinces among dyads of children (11-14 years) or youth (15-18 years) and a parent (> 18 years). Self-report questions on mental health were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. McNemar's test and the test of homogeneity of stratum effects were used to assess differences between children-parent and youth-parent dyads, and interaction by stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) parents were aged 35-44 years and 485 (52.0%) parents were women; 227 (47.0%) children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in Canada < 10 years. Anxiety and irritability were reported most frequently among child (44, 9.1%; 37, 7.7%) and parent (82, 17.0%; 67, 13.9%) dyads, as well as among youth (44, 9.8%; 35, 7.8%) and parent (68, 15.1%; 49, 10.9%) dyads; children and youth were significantly less likely to report worsened anxiety (p < 0.001, p = 0.006, respectively) or inattention (p < 0.001, p = 0.028, respectively) compared to parents. Dyads who reported financial or housing instability or identified as living with a disability more frequently reported worsened mental health. Children (96, 57.1%), youth (113, 62.5%), and their parents (253, 62.5%; 239, 62.6%, respectively) most frequently accessed the internet for mental health information. This cross-national survey contextualizes pandemic-related changes to self-reported mental health symptoms of children, youth, and families.
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Affiliation(s)
| | | | | | | | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott Halperin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, University of Hawaii John A Burns School of Medicine, Honolulu, HI, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Henry T Stelfox
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Quinn AE, Drummond R, Clement F, Columbus M, Moss SJ, Fitzgerald E, Daya R, Mastikhina L, Leigh JP, Stelfox HT. A North Star Vision: Results from a Deliberative Dialogue to Identify Policy Strategies to Improve Value in Healthcare. Healthc Policy 2023; 18:120-133. [PMID: 37486817 PMCID: PMC10370391 DOI: 10.12927/hcpol.2023.27089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We hosted a deliberative dialogue with citizens (n = 3), policy researchers (n = 3), government decision makers (n = 3) and health system leaders (n = 3) to identify evidence-informed policy options to improve the value of Canadian healthcare. The analysis resulted in three themes: (1) the need for a vision to guide reforms, (2) community-based care and (3) community-engaged care. Results suggest the need for a new paradigm: community-focused health systems. Such a paradigm could serve as a North Star guiding healthcare transformation, improving value by aligning citizen and healthcare system goals, prioritizing spending on services that address the social determinants of health and improving quality and equity.
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Affiliation(s)
- Amity E Quinn
- Postdoctoral Fellow, Department of Medicine, Cumming School of Medicine, University of Calgary, Senior Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Rachelle Drummond
- Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Fiona Clement
- Professor, Department of Community Health Science, Cumming School of Medicine, University of Calgary, Member, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Melanie Columbus
- Health Policy Manager, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Stephana J Moss
- Banting Postdoctoral Fellow, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, CRISMA Center, University of Pittsburgh, Pittsburgh, PA
| | - Emily Fitzgerald
- Research Associate, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Rukhsaar Daya
- Community Engagement Specialist, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, kARLA KREWULAK, PhD, Senior Research Associate, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Liza Mastikhina
- Unit Manager, Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Jeanna Parsons Leigh
- Assistant Professor Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Henry T Stelfox
- On behalf of the Health Policy Forum Panellists, Scientific Director, O'Brien Institute for Public Health, University of Calgary, Professor, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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Moss SJ, Mizen SJ, Stelfox M, Mather RB, FitzGerald EA, Tutelman P, Racine N, Birnie KA, Fiest KM, Stelfox HT, Parsons Leigh J. Interventions to improve well-being among children and youth aged 6-17 years during the COVID-19 pandemic: a systematic review. BMC Med 2023; 21:131. [PMID: 37013542 PMCID: PMC10069351 DOI: 10.1186/s12916-023-02828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is an example of a global infectious disease outbreak that poses a threat to the well-being of children and youth (e.g., physical infection, psychological impacts). The consequences of challenges faced during COVID-19 may be longstanding and newly developed interventions are being deployed. We present a narrative synthesis of available evidence from the first 2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects of interventions to improve well-being among children and youth to inform the development and refinement of interventions relevant to post-pandemic recovery. METHODS Six databases were searched from inception to August 2022. A total of 5484 records were screened, 39 were reviewed in full text, and 19 studies were included. The definition of well-being and the five domains of well-being as defined by the Partnership for Maternal, Newborn & Child Health and the World Health Organization in collaboration with the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being were used. RESULTS Nineteen studies (74% randomized controlled trials) from 10 countries were identified, involving a total of 7492 children and youth (age range: 8.2-17.2 years; 27.8-75.2% males) and 954 parents that occurred during the COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), while fewer studies targeted agency and resilience (n = 5, 23%), learning and competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions (26%) were self-guided while 13 interventions (68%) were guided synchronous by a trained professional, all of which targeted physical and mental health subdomains within health and nutrition; one intervention (5%) was unclear. CONCLUSIONS Studies deploying synchronous interventions most often reported improved well-being among children and youth largely in the domain of health and nutrition, specifically physical and mental health. Targeted approaches will be crucial to reach sub-groups of children and youth who are most at risk of negative well-being outcomes. Further research is needed to determine how interventions that best supported children and youth early in the pandemic are different from interventions that are required now as we enter into the post-pandemic phase.
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Affiliation(s)
- Stephana J Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Maia Stelfox
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Brundin Mather
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Perri Tutelman
- Faculty of Science, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn A Birnie
- Cumming School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Alberta, Canada
- Cumming School of Medicine, Department of Community Health Sciences, Calgary, AB, Canada
| | - Kirsten M Fiest
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Department of Community Health Sciences, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
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11
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Parsons Leigh J, Moss SJ, Mizen SJ, FitzGerald EA, Brundin-Mather R, de Grood C, Dodds A, Stelfox HT, Fiest KM. Exploring the influence of behavioural, normative and control beliefs on intentions to adhere to public health guidelines during the COVID-19 pandemic: a qualitative interview based study. BMC Public Health 2023; 23:464. [PMID: 36899337 PMCID: PMC9999336 DOI: 10.1186/s12889-023-15344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Perceived severity and susceptibility of disease are predictors of individual behaviour during health crises. Little is known about how individual beliefs influence intentions to adhere to public health guidelines during periods of health crises, and how access to and consumption of information influence these intentions. This study investigated behavioural beliefs, normative beliefs, and control beliefs, and their influence on behavioural intentions to adhere to public health guidelines during the COVID-19 pandemic. METHODS Participants were recruited from a related COVID-19 study conducted by our team, and through snowball sampling in subsequent. Using a maximum variation sampling technique, we recruited a diverse group of participants representing six major regions in Canada. Participants took part in one-on-one semi-structured interviews from February 2021 to May 2021. Data were analyzed independently in duplicate by thematic analysis. The Theory of Planned Behaviour (TPB) was the conceptual framework used to organize dominant themes. RESULTS We conducted a total of 60 individual interviews (137 eligible individuals contacted, 43.8% response rate) and identified six themes organized according to the three constructs of behavioural, normative and control beliefs as described in the TPB: (1) Behavioural: My "New Normal," Individual Rights and Perceived Pandemic Severity, Fatigue with COVID-19, (2) Normative: COVID-19 Collective, (3) Control: Practicality of Public Health Guidelines, and (6) Conflicting Public Health Messages. Most (n = 43, 71.7%) participants perceived individuals in their geographic community to be following public health guidelines adequately. Several participants (n = 15, 25.0%) commented on the unequal impact of restrictions based on socioeconomic factors (i.e., class, race, age). CONCLUSION Individual perceptions of risk, loss of control, access to resources (i.e., childcare), and societal expectations, shaped intentions to engage in disease preventative behaviours (i.e., social distancing) during the COVID-19 pandemic.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Chloe de Grood
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Embrett M, Packer TL, Fitzgerald E, Jaswal SK, Lehman MJ, Brown M, Burge F, Christian E, Isenor JE, Marshall EG, Martin-Misener R, Sampalli T, Zed J, Leigh JP. The impact of the COVID-19 pandemic on primary care physicians and nurses in Nova Scotia: a qualitative exploratory study. CMAJ Open 2023; 11:E274-E281. [PMID: 36944428 PMCID: PMC10035666 DOI: 10.9778/cmajo.20210315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic. METHODS We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. RESULTS Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. INTERPRETATION Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.
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Affiliation(s)
- Mark Embrett
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tanya L Packer
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Fitzgerald
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Sabrena K Jaswal
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Michelle J Lehman
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Marion Brown
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Fred Burge
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Erin Christian
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jennifer E Isenor
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Gard Marshall
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Ruth Martin-Misener
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tara Sampalli
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Joanna Zed
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jeanna Parsons Leigh
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
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Parsons Leigh J, Mizen SJ, Moss SJ, Brundin-Mather R, de Grood C, Dodds A, Honarmand K, Shah S, Mehta S. A qualitative descriptive study of the impact of the COVID-19 pandemic on staff in a Canadian intensive care unit. Can J Anaesth 2023; 70:384-394. [PMID: 36627462 PMCID: PMC9831684 DOI: 10.1007/s12630-022-02377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE We sought to explore the lived experiences of a professionally diverse sample of healthcare workers (HCWs) in a single intensive care unit (ICU) serving a large and generalizable Canadian population. We aimed to understand how working during the COVID-19 pandemic affected their professional and personal lives, including their perceptions of institutional support, to inform interventions to ameliorate impacts of the COVID-19 and future pandemics. METHODS In this qualitative descriptive study, 23 ICU HCWs, identified using convenience purposive sampling, took part in individual semistructured interviews between July and November 2020, shortly after the first wave of the pandemic in Ontario. We used inductive thematic analysis to identify major themes. RESULTS We identified five major themes related to the COVID-19 pandemic: 1) communication and informational needs (e.g., challenges communicating policy changes); 2) adjusting to restricted visitation (e.g., spending less time interacting with patients); 3) staffing and workplace supports (e.g., importance of positive team dynamics); 4) permeability of professional and personal lives (e.g., balancing shift work and childcare); and 5) a dynamic COVID-19 landscape (e.g., coping with constant change). The COVID-19 pandemic contributed to HCWs in the ICU experiencing varied negative repercussions on their work environment, including staffing and institutional support, which carried into their personal lives. CONCLUSION Healthcare workers in the ICU perceived that the COVID-19 pandemic had negative repercussions on their work environment, including staffing and institutional support, as well as their professional and personal lives. Understanding both the negative and positive experiences of all ICU HCWs working during the COVID-19 pandemic is critical to future pandemic preparedness. Their perspectives will help to inform the development of mental health and wellbeing interventions to support staff during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, Second Floor, 2A01, Office 2A08, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Sara J Mizen
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Stephana Julia Moss
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Chloe de Grood
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Alexandra Dodds
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Sumesh Shah
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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14
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Li A, Dreksler H, Nagpal SK, Brandys T, Jetty P, Dubois L, Parsons Leigh J, Stelfox HT, McIsaac DI, Roberts DJ. Outcomes After Neuraxial or Regional Anaesthesia Instead of General Anaesthesia for Lower Limb Revascularisation Surgery: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Studies. Eur J Vasc Endovasc Surg 2023; 65:379-390. [PMID: 36336286 DOI: 10.1016/j.ejvs.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/19/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether receipt of neuraxial or regional anaesthesia instead of general anaesthesia for lower limb revascularisation surgery affects patient outcomes. DATA SOURCES MEDLINE, EMBASE, Evidence Based Medicine Reviews, and Google Scholar. REVIEW METHODS After protocol registration, the data sources were searched for randomised and non-randomised studies comparing neuraxial or regional anaesthesia with general anaesthesia for lower limb revascularisation surgery in adults. Two investigators independently selected articles, extracted data, and assessed risks of bias. Data were pooled using random effects models. GRADE was used to assess certainty in cumulative evidence. RESULTS From 10 755 citations identified, five randomised (n = 970) and 13 non-randomised (n = 96 800) studies were included. Use of neuraxial instead of general anaesthesia for lower limb revascularisation surgery was associated with no statistically significant reduction in short term (in hospital or 30 day) mortality in randomised studies (pooled odds ratio [OR] 0.77; 95% confidence interval [CI] 0.33 - 1.81; low certainty) and a statistically significant reduction in adjusted short term mortality in non-randomised studies (pooled OR 0.67; 95% CI 0.56 - 0.81; low certainty). Adults allocated to neuraxial anaesthesia in randomised studies had fewer pulmonary complications (pooled OR 0.35; 95% CI 0.16 - 0.76; low certainty). In non-randomised studies, neuraxial instead of general anaesthesia was associated with a lower adjusted odds of any morbidity (pooled OR 0.66; 95% CI 0.52 - 0.84), cardiac complications (pooled OR 0.68; 95% CI 0.58 - 0.79), pneumonia (pooled OR 0.81; 95% CI 0.64 - 1.02), prolonged mechanical ventilation (OR 0.09; 95% CI 0.002 - 0.55), and bypass graft thrombosis (OR 0.70; 95% CI 0.59 - 0.85), as well as a shorter operative duration (low certainty for all). Use of a nerve block instead of general anaesthesia was associated with a lower adjusted odds of delirium (OR 0.16; 95% CI 0.06 - 0.42) and a shorter operative duration (low certainty for both). CONCLUSION Randomised and non-randomised data suggest that neuraxial anaesthesia for lower limb revascularisation surgery reduces morbidity and possibly mortality. Until randomised trials with a low risk of bias become available, this study supports use of neuraxial anaesthesia for these procedures where appropriate.
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Affiliation(s)
- Allen Li
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Hannah Dreksler
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Timothy Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada; ICES, Ontario, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Alberta, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; ICES, Ontario, Canada; Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; O'Brien Institute for Public Health, University of Calgary, Alberta, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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15
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Tricco AC, Nincic V, Darvesh N, Rios P, Khan PA, Ghassemi MM, MacDonald H, Yazdi F, Lai Y, Warren R, Austin A, Cleary O, Baxter NN, Burns KEA, Coyle D, Curran JA, Graham ID, Hawker G, Légaré F, Watt J, Witteman HO, Clark JP, Bourgeault IL, Parsons Leigh J, Ahmed SB, Lawford K, Aiken AB, Langlois EV, McCabe C, Shepperd S, Skidmore B, Pattani R, Leon N, Lundine J, Adisso ÉL, El-Adhami W, Straus SE. Global evidence of gender equity in academic health research: a scoping review. BMJ Open 2023; 13:e067771. [PMID: 36792322 PMCID: PMC9933760 DOI: 10.1136/bmjopen-2022-067771] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To chart the global literature on gender equity in academic health research. DESIGN Scoping review. PARTICIPANTS Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER Open Science Framework: https://osf.io/8wk7e/.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marco M Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rachel Warren
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alyssa Austin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olga Cleary
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Nancy N Baxter
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Melbourne, Australia
| | - Karen E A Burns
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- HEI, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet A Curran
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - France Légaré
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Holly O Witteman
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
- Office of Education and Professional Development, Université Laval, Quebec City, Québec, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Lancet Ltd, London, London, UK
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Lawford
- Department of Gender Studies, Queen's University, Haudenosaunee and Anishinaabek Territories, Settlement of Kingston, Ontario, Canada
| | - Alice B Aiken
- Department of Research and Innovation, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), WHO, Geneve, Switzerland
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, Alberta, Canada
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Reena Pattani
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Internal Medicine, Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec City, Quebec, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Canberra, ACT, Australia
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
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Shahid A, Lalani IN, Rosgen BK, Sept BG, Longmore S, Parsons Leigh J, Stelfox HT, Fiest KM. A scoping review of methods to measure and evaluate citizen engagement in health research. Res Involv Engagem 2022; 8:72. [PMID: 36496455 PMCID: PMC9737710 DOI: 10.1186/s40900-022-00405-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/29/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Citizen engagement, or partnering with interested members of the public in health research, is becoming more common. While ongoing assessment of citizen engagement practices is considered important to its success, there is little clarity around aspects of citizen engagement that are important to assess (i.e., what to look for) and methods to assess (i.e., how to measure and/ or evaluate) citizen engagement in health research. METHODS In this scoping review, we included peer-reviewed literature that focused primarily on method(s) to measure and/or evaluate citizen engagement in health research. Independently and in duplicate, we completed title and abstract screening and full-text screening and extracted data including document characteristics, citizen engagement definitions and goals, and methods to measure or evaluate citizen engagement (including characteristics of these methods). RESULTS Our search yielded 16,762 records of which 33 records (31 peer-reviewed articles, one government report, one conference proceeding) met our inclusion criteria. Studies discussed engaging citizens (i.e., patients [n = 16], members of the public [n = 7], service users/consumers [n = 4], individuals from specific disease groups [n = 3]) in research processes. Reported methods of citizen engagement measurement and evaluation included frameworks, discussion-based methods (i.e., focus groups, interviews), survey-based methods (e.g., audits, questionnaires), and other methods (e.g., observation, prioritization tasks). Methods to measure and evaluate citizen engagement commonly focused on collecting perceptions of citizens and researchers on aspects of citizen engagement including empowerment, impact, respect, support, and value. DISCUSSION AND CONCLUSION We found that methods to measure and/or evaluate citizen engagement in health research vary widely but share some similarities in aspect of citizen engagement considered important to measure or evaluate. These aspects could be used to devise a more standardized, modifiable, and widely applicable framework for measuring and evaluating citizen engagement in research. PATIENT OR PUBLIC CONTRIBUTION Two citizen team members were involved as equal partners in study design and interpretation of its findings. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (10.17605/OSF.IO/HZCBR).
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Inara N Lalani
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Parsons Leigh J, Halperin D, Mizen SJ, FitzGerald EA, Moss SJ, Fiest KM, Di Castri A, Stelfox HT, Halperin S. Exploring the impact of media and information on self-reported intentions to vaccinate against COVID-19: A qualitative interview-based study. Hum Vaccin Immunother 2022; 18:2048623. [PMID: 35417284 PMCID: PMC9196778 DOI: 10.1080/21645515.2022.2048623] [Citation(s) in RCA: 8] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The World Health Organization declared vaccine hesitancy a top threat to global health following resurgence of vaccine-preventable diseases close to eradication in many countries (e.g. measles). Vaccines are effective in preventing severe illness, hospitalization, and death from COVID-19, yet there remains a small proportion of the eligible population who choose not to vaccinate. Social media and online news sources are opportunities for targeted public health interventions to improve vaccine uptake. This study reports the results of a semi-structured interview study that explored the influence of media and information on individuals' self-reported intentions to vaccinate against COVID-19. METHODS A qualitative descriptive study was employed to gain insight from a diverse group of individuals. Adult participants were recruited through a related COVID-19 study; we used a maximum variation sampling technique and purposively sampled participants based on demographics. Interviews were conducted from February 2021 to May 2021. Themes from interviews were summarized with representative quotations according to the 3C Theoretical Framework (Confidence, Complacency, Convenience). RESULTS Key themes identified following thematic analysis from 60 participants included: vaccine safety, choice of vaccine, fear mongering, trust in authority, belief in vaccinations (Confidence); delaying vaccination (Complacency); confusing information, access to vaccines and information (Convenience). While most participants intended to vaccinate, many expressed concerns and hesitancy. CONCLUSIONS COVID-19 vaccine hesitancy prevents universal immunization and contradictory messages in media are a source of concern and fear. The success of future vaccine campaigns will depend upon authorities' ability to disseminate accessible, detailed, and consistent information promoting public confidence.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna Halperin
- Canadian Center for Vaccinology & Scientific Staff, IWK Health Center, Halifax, Nova Scotia, Canada.,Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Antonia Di Castri
- Canadian Center for Vaccinology & Scientific Staff, IWK Health Center, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Scott Halperin
- Canadian Center for Vaccinology & Scientific Staff, IWK Health Center, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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18
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Dubé E, Labbé F, Malo B, Manca T, Aylsworth L, Driedger SM, Graham J, Greyson D, MacDonald N, Meyer SB, Parsons Leigh J, Sadarangani M, Wilson S, MacDonald SE. " I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2088970. [PMID: 35767434 PMCID: PMC9621068 DOI: 10.1080/21645515.2022.2088970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients. METHODS Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted. RESULTS Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program. CONCLUSIONS While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Wilson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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19
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Parsons Leigh J, Brundin-Mather R, Moss SJ, Nickel A, Parolini A, Walsh D, Bigham BL, Carter AJE, Fox-Robichaud A, Fiest KM. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care 2022; 26:337. [PMID: 36329489 PMCID: PMC9632573 DOI: 10.1186/s13054-022-04215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Sepsis is a life-threatening complication of the body’s response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult’s sepsis knowledge in Canada. Methods We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao–Scott correction for weighted chi-squared tests and associations using multiple variable regression. Results Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent’s residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent’s knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). Conclusions Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04215-6.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada. .,Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
| | | | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Angie Nickel
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ariana Parolini
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre Walsh
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Blair L Bigham
- Division of Critical Care, Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services Nova Scotia, Halifax, NS, Canada
| | - Alison Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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20
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Manca T, Humble RM, Aylsworth L, Cha E, Wilson SE, Meyer SB, Greyson D, Sadarangani M, Parsons Leigh J, MacDonald SE. "We need to protect each other": COVID-19 vaccination intentions and concerns among Racialized minority and Indigenous Peoples in Canada. Soc Sci Med 2022; 313:115400. [PMID: 36206660 PMCID: PMC9519366 DOI: 10.1016/j.socscimed.2022.115400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/20/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 01/26/2023]
Abstract
People may choose to receive vaccines in response to pressures that outweigh any concerns that they have. We explored Racialized minority and Indigenous Peoples' motivations for, perceptions of choice in, and concerns about, COVID-19 vaccination. We used a sequential explanatory mixed methods approach, including a national survey administered around the time vaccines were first authorized (Dec 2020) followed by qualitative interviews when vaccines were becoming more readily available to adults (May-June 2021). We analyzed survey data using descriptive statistics and interviews using critical feminist methodologies. Survey respondents self-identified as a Racialized minority (n = 1488) or Indigenous (n = 342), of which 71.4% and 64.6%, respectively, intended to receive a COVID-19 vaccine. Quantitative results indicated perceptions of COVID-19 disease were associated with vaccination intention. For instance, intention was associated with agreement that COVID-19 disease is severe, risk of becoming sick is great, COVID-19 vaccination is necessary, and vaccines available in Canada will be safe (p < 0.001). COVID-19 vaccines were in short supply in Canada when we subsequently completed qualitative interviews with a subset of Racialized minority (n = 17) and Indigenous (n = 10) survey respondents. We coded interview transcripts around three emergent themes relating to governmentality and cultural approaches to intersectional risk theories: feelings of collective responsibility, choice as privilege, and remaining uncertainties about COVID-19 vaccines. For example, some mentioned the responsibility and privilege to receive a vaccine earlier than those living outside of Canada. Some felt constraints on their freedom to choose to receive or refuse a vaccine from intersecting oppressions or their health status. Although all participants intended to get vaccinated, many mentioned uncertainties about the safety and effectiveness of COVID-19 vaccination. Survey respondents and interview participants demonstrated nuanced associations of vaccine acceptance and hesitancy shaped by perspectives of vaccine-related risks, symbolic associations of vaccines with hope, and intersecting social privileges and inequities (including racialization).
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Affiliation(s)
- Terra Manca
- Faculty of Nursing, University of Alberta, Canada,Corresponding author
| | | | | | - Eunah Cha
- Faculty of Nursing, University of Alberta, Canada
| | - Sarah E. Wilson
- Public Health Ontario, ICES, Canada,Dalla School of Public Health, University of Toronto, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada,Department of Pediatrics, University of British Columbia, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Canada,School of Public Health, University of Alberta, Canada
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21
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Fiest KM, Krewulak KD, Jaworska N, Spence KL, Mizen SJ, Bagshaw SM, Burns KEA, Cook DJ, Fowler RA, Olafson K, Patten SB, Rewa OG, Rochwerg B, Spence S, West A, Stelfox HT, Parsons Leigh J. Impact of restricted visitation policies during COVID-19 on critically ill adults, their families, critical care clinicians, and decision-makers: a qualitative interview study. Can J Anaesth 2022; 69:1248-1259. [PMID: 35978160 PMCID: PMC9385091 DOI: 10.1007/s12630-022-02301-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/22/2022] [Accepted: 04/11/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE During the first wave of the COVID-19 pandemic, restricted visitation policies were enacted at acute care facilities to reduce the spread of COVID-19 and conserve personal protective equipment. In this study, we aimed to describe the impact of restricted visitation policies on critically ill patients, families, critical care clinicians, and decision-makers; highlight the challenges faced in translating these policies into practice; and delineate strategies to mitigate their effects. METHOD A qualitative description design was used. We conducted semistructured interviews with critically ill adult patients and their family members, critical care clinicians, and decision-makers (i.e., policy makers or enforcers) affected by restricted visitation policies. We transcribed semistructured interviews verbatim and analyzed the transcripts using inductive thematic analysis. RESULTS Three patients, eight family members, 30 clinicians (13 physicians, 17 nurses from 23 Canadian intensive care units [ICUs]), and three decision-makers participated in interviews. Thematic analysis was used to identify five themes: 1) acceptance of restricted visitation (e.g., accepting with concerns); 2) impact of restricted visitation (e.g., ethical challenges, moral distress, patients dying alone, intensified workload); 3) trust in the healthcare system during the pandemic (e.g., mistrust of clinical team); 4) modes of communication (e.g., communication using virtual platforms); and 5) impact of policy implementation on clinical practice (e.g., frequent changes and inconsistent implementation). CONCLUSIONS Restricted visitation policies across ICUs during the COVID-19 pandemic negatively affected critically ill patients and their families, critical care clinicians, and decision-makers.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
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22
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Sypes EE, Leigh JP, Stelfox HT, Niven DJ. Context, Culture, and the Complexity of De-Implementing Low-Value Care Comment on "Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands". Int J Health Policy Manag 2022; 11:1592-1594. [PMID: 35174681 PMCID: PMC9808337 DOI: 10.34172/ijhpm.2022.6968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/22/2022] [Indexed: 01/12/2023] Open
Abstract
Low-value care contributes to poor quality of care and wasteful spending in healthcare systems. In Verkerk and colleagues' recent qualitative study, interviews with low-value care experts from Canada, the United States, and the Netherlands identified a broad range of nationally relevant social, system, and knowledge factors that promote ongoing use of low-value care. These factors highlight the complexity of the problem that is persistent use of low-value care and how it is heavily influenced by public and medical culture as well as healthcare system features. This commentary discusses how these findings integrate within current low-value care and de-implementation literature and uses specific low-value care examples to highlight the importance of considering context, culture, and clinical setting when considering how to apply these factors to future de-implementation initiatives.
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Affiliation(s)
- Emma E. Sypes
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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23
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Moss SJ, Lorenzetti DL, FitzGerald EA, Smith S, Harley M, Tutelman PR, Birnie K, Mizen SJ, Anglin MC, Stelfox HT, Fiest KM, Parsons Leigh J. Strategies to mitigate the impact of the COVID-19 pandemic on child and youth well-being: a scoping review protocol. BMJ Open 2022; 12:e062413. [PMID: 35879014 PMCID: PMC9327437 DOI: 10.1136/bmjopen-2022-062413] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Children and youth are often more vulnerable than adults to emotional impacts of trauma. Wide-ranging negative effects (eg, social isolation, lack of physical activity) of the COVID-19 pandemic on children and youth are well established. This scoping review will identify, describe and categorise strategies taken to mitigate potentially deleterious impacts of the COVID-19 pandemic on children, youth and their families. METHODS AND ANALYSIS We will conduct a scoping review following the Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. Well-being will be operationalised according to pre-established domains (health and nutrition, connectedness, safety and support, learning and competence, and agency and resilience). Articles in all languages for this review will be identified in CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, ERIC, Education Research Complete, MEDLINE and APA PsycINFO. The search strategy will be restricted to articles published on or after 1 December 2019. We will include primary empirical and non-empirical methodologies, excluding protocols, reports, opinions and editorials, to identify new data for a broad range of strategies to mitigate potentially deleterious impacts of the COVID-19 pandemic on child and youth well-being. Two reviewers will calibrate screening criteria and the data abstraction form and will independently screen records and abstract data. Data synthesis will be performed according to the convergent integrated approach described by the Joanna Briggs Institute. ETHICS AND DISSEMINATION Ethical approval is not applicable as this review will be conducted on published data. Findings of this study will be disseminated at national and international conferences and will inform our pan-Canadian multidisciplinary team of researchers, public, health professionals and knowledge users to codesign and pilot test a digital psychoeducational health tool-an interactive, web-based tool to help Canadian youth and their families address poor mental well-being resulting from and persisting beyond the COVID-19 pandemic.
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Affiliation(s)
| | - Diane L Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Stacie Smith
- Young Canadians Roundtable on Health, Toronto, Ontario, Canada
| | | | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kathryn Birnie
- Departments of Anesthesiology, Perioperative and Pain Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sara J Mizen
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie C Anglin
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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24
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Shahid A, Sept B, Kupsch S, Brundin-Mather R, Piskulic D, Soo A, Grant C, Leigh JP, Fiest KM, Stelfox HT. Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients. World J Crit Care Med 2022; 11:255-268. [PMID: 36051938 PMCID: PMC9305680 DOI: 10.5492/wjccm.v11.i4.255] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings.
AIM To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility.
METHODS Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients’ specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses.
RESULTS Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient’s health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was “not reasonable” in their daily clinical workflow due to “time constraint”.
CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary T2N 4Z6, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
- School of Health Administration, Dalhousie University, Halifax B3H 4R2, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
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25
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Fiest KM, Krewulak KD, Hernández LC, Jaworska N, Makuk K, Schalm E, Bagshaw SM, Bernet X, Burns KEA, Couillard P, Doig CJ, Fowler R, Kho ME, Kupsch S, Lauzier F, Niven DJ, Oggy T, Rewa OG, Rochwerg B, Spence S, West A, Stelfox HT, Parsons Leigh J. Evidence-informed consensus statements to guide COVID-19 patient visitation policies: results from a national stakeholder meeting. Can J Anaesth 2022; 69:868-879. [PMID: 35359262 PMCID: PMC8970637 DOI: 10.1007/s12630-022-02235-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs. METHODS We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies. RESULTS Through discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews). CONCLUSIONS Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, Calgary, AB, Canada.
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Laura C Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Emma Schalm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Xavier Bernet
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Physiotherapy, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - François Lauzier
- Departments of Medicine and Anesthesiology & Critical Care, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Taryn Oggy
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Parsons Leigh J, Moss SJ, White TM, Picchio CA, Rabin KH, Ratzan SC, Wyka K, El-Mohandes A, Lazarus JV. Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries. Vaccine 2022; 40:4081-4089. [PMID: 35654620 PMCID: PMC9068669 DOI: 10.1016/j.vaccine.2022.04.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022]
Abstract
Background Several early COVID-19 studies aimed to assess the potential acceptance of a vaccine among healthcare providers, but relatively few studies of this population have been published since the vaccines became widely available. Vaccine safety, speed of development, and low perceived disease risk were commonly cited as factors for COVID-19 vaccine hesitancy among this group. Purpose and methods In a secondary analysis based on a cross-sectional, structured survey, the authors aimed to assess the associations between self-reported vaccine hesitancy and a number of sociodemographic and COVID-19 vaccine perception factors using data from 3,295 healthcare providers (physicians, nurses, community health workers, other healthcare providers) in 23 countries. Findings 494 (15.0%) of the participants reported vaccine hesitancy, of whom 132 (4.0%) would outright refuse to accept a COVID-19 vaccine. Physicians were the least hesitant. Vaccine hesitancy was more likely to occur among those with less than the median income and, to a lesser degree, younger age. Safety and risk concerns and lack of trust that vaccines would be equitably distributed were strongly associated with hesitancy, less so were concerns about the efficacy of COVID-19 vaccines. Interpretation Findings suggest a need to address safety and risk concerns through tailored messaging, training, and/or incentive approaches among healthcare providers, as well as the need for international and national vaccination efforts to ensure equitable distribution.
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Fullerton MM, Benham J, Graves A, Fazel S, Doucette EJ, Oxoby RJ, Mourali M, Boucher JC, Constantinescu C, Parsons Leigh J, Tang T, Marshall DA, Hu J, Lang R. Challenges and recommendations for COVID-19 public health messaging: a Canada-wide qualitative study using virtual focus groups. BMJ Open 2022; 12:e054635. [PMID: 35418426 PMCID: PMC9013785 DOI: 10.1136/bmjopen-2021-054635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To understand Canadian's attitudes and current behaviours towards COVID-19 public health measures (PHM), vaccination and current public health messaging, to provide recommendations for a public health intervention. DESIGN Ten focus groups were conducted with 2-7 participants/group in December 2020. Focus groups were transcribed verbatim and analysed using content and inductive thematic analysis. The capability opportunity motivation behaviour Model was used as our conceptual framework. SETTING Focus groups were conducted virtually across Canada. PARTICIPANTS Participants were recruited from a pool of individuals who previously completed a Canada-wide survey conducted by our research team. MAIN OUTCOME MEASURE Key barriers and facilitators towards COVID-19 PHM and vaccination, and recommendations for public health messaging. RESULTS Several themes were identified (1) participants' desire to protect family and friends was the main facilitator for adhering to PHM, while the main barrier was inconsistent PHM messaging and (2) participants were optimistic that the vaccine offers a return to normal, however, worries of vaccine efficacy and effectiveness were the main concerns. Participants felt that current public health messaging is inconsistent, lacks transparency and suggested that messaging should include scientific data presented by a trustworthy source. CONCLUSIONS We suggest six public health messaging recommendations to increase adherence to PHM and vaccination (1) use an unbiased scientist as a spokesperson, (2) openly address any unknowns, (3) more is better when sharing data, (4) use personalised stories to reinforce PHM and vaccinations, (5) humanise the message by calling out contradictions and (6) focus on the data and keep politics out.
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Affiliation(s)
- Madison M Fullerton
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jamie Benham
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sajjad Fazel
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - Emily J Doucette
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Oxoby
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | | | - Cora Constantinescu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Theresa Tang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leigh JP, Brundin-Mather R, Soo A, FitzGerald E, Mizen S, Dodds A, Ahmed S, Burns KEA, Plotnikoff KM, Rochwerg B, Perry JJ, Benham JL, Honarmand K, Hu J, Lang R, Stelfox HT, Fiest K. Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition. BMC Public Health 2022; 22:699. [PMID: 35397530 PMCID: PMC8994420 DOI: 10.1186/s12889-022-13058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.
Methods
We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.
Results
We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.
Conclusion
This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.
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de Grood C, Sypes EE, Niven DJ, Clement F, FitzGerald EA, Kupsch S, King-Hunter S, Stelfox HT, Parsons Leigh J. Patient and family involvement in Choosing Wisely initiatives: a mixed methods study. BMC Health Serv Res 2022; 22:457. [PMID: 35392900 PMCID: PMC8991491 DOI: 10.1186/s12913-022-07861-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/29/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients are important stakeholders in reducing low-value care, yet mechanisms for optimizing their involvement in low-value care remain unclear. To explore the role of patients in the development and implementation of Choosing Wisely recommendations to reduce low-value care and to assess the likelihood that existing patient resources will change patient health behaviour. METHODS Three phased mixed-methods study: 1) content analysis of all publicly available Choosing Wisely clinician lists and patient resources from the United States of America and Canada. Quantitative data was summarized with frequencies and free text comments were analyzed with qualitative thematic content analysis; 2) semi-structured telephone interviews with a purposive sample of representatives of professional societies who created Choosing Wisely clinician lists and members of the public (including patients and family members). Interviews were transcribed verbatim, and two researchers conducted qualitative template analysis; 3) evaluation of Choosing Wisely patient resources. Two public partners were identified through the Calgary Critical Care Research Network and independently answered two free text questions "would this change your health behaviour" and "would you discuss this material with a healthcare provider". Free text data was analyzed by two researchers using thematic content analysis. RESULTS From the content analysis of 136 Choosing Wisely clinician lists, six reported patient involvement in their development. From 148 patient resource documents that were mapped onto a conceptual framework (Inform, Activate, Collaborate) 64% described patient engagement at the level of Inform (educating patients). From 19 interviews stakeholder perceptions of patient involvement in reducing low-value care were captured by four themes: 1) impact of perceived power dynamics on the discussion of low-value care in the clinical interaction, 2) how to communicate about low-value care, 3) perceived barriers to patient involvement in reducing low-value care, and 4) suggested strategies to engage patients and families in Choosing Wisely initiatives. In the final phase of work in response to the question "would this change your health behaviour" two patient partners agreed 'yes' on 27% of patient resources. CONCLUSIONS Opportunities exist to increase patient and family participation in initiatives to reduce low-value care.
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Affiliation(s)
- Chloe de Grood
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emma E Sypes
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly King-Hunter
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
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Leigh JP, Sypes EE, Straus SE, Demiantschuk D, Ma H, Brundin-Mather R, de Grood C, FitzGerald EA, Mizen S, Stelfox HT, Niven DJ. Determinants of the de-implementation of low-value care: a multi-method study. BMC Health Serv Res 2022; 22:450. [PMID: 35387673 PMCID: PMC8985316 DOI: 10.1186/s12913-022-07827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is an urgent need to understand the determinants (i.e., barriers and facilitators) of de-implementation. The purpose of this study was to develop a comprehensive list of determinants of the de-implementation of low-value care from the published literature and to compare this list to determinants identified by a group of stakeholders with lived experience with de-implementation. Methods This was a two-phase multi-method study. First, a systematic review examined published barriers and facilitators to de-implementation. Articles were identified through searches within electronic databases, reference lists and the grey literature. Citations were screened independently and in duplicate and included if they were: 1) written in English; and 2) described a barrier or facilitator to de-implementation of any clinical practice in adults (age ≥ 18 years). ‘Raw text’ determinants cited within included articles were extracted and synthesized into a list of representative determinants using conventional content analysis. Second, semi-structured interviews were conducted with decision-makers (unit managers and medical directors) and healthcare professionals working in adult critical care medicine to explore the overlap between the determinants found in the systematic review to those experienced in critical care medicine. Thematic content analysis was used to identify key themes emerging from the interviews. Results In the systematic review, reviewers included 172 articles from 35,368 unique citations. From 437 raw text barriers and 280 raw text facilitators, content analysis produced 29 distinct barriers and 24 distinct facilitators to de-implementation. Distinct barriers commonly cited within raw text included ‘lack of credible evidence to support de-implementation’ (n = 90, 21%), ‘entrenched norms and clinicians’ resistance to change (n = 43, 21%), and ‘patient demands and preferences’ (n = 28, 6%). Distinct facilitators commonly cited within raw text included ‘stakeholder collaboration and communication’ (n = 43, 15%), and ‘availability of credible evidence’ (n = 33, 12%). From stakeholder interviews, 23 of 29 distinct barriers and 20 of 24 distinct facilitators from the systematic review were cited as key themes relevant to de-implementation in critical care. Conclusions The availability and quality of evidence that identifies a clinical practice as low-value, as well as healthcare professional willingness to change, and stakeholder collaboration are common and important determinants of de-implementation and may serve as targets for future de-implementation initiatives. Trial registration The systematic review was registered in PROSPERO CRD42016050234. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07827-4.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Emma E Sypes
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Henry Ma
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Chloe de Grood
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Emily A FitzGerald
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Sara Mizen
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Leigh JP, Moss SJ, Tiifu F, FitzGerald E, Brundin-Mathers R, Dodds A, Brar A, de Grood CM, Stelfox HT, Fiest KM, Ng-Kamstra J. Lived experiences of Asian Canadians encountering discrimination during the COVID-19 pandemic: a qualitative interview study. CMAJ Open 2022; 10:E539-E545. [PMID: 35700997 PMCID: PMC9343119 DOI: 10.9778/cmajo.20220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Asian Canadians have experienced increased cases of racialized discrimination after the first emergence of SARS-CoV-2 in China. This study examined how the COVID-19 pandemic has affected Asian Canadians' sense of safety and belonging in their Canadian (i.e., geographical) communities. METHODS We applied a qualitative description study design in which semistructured interviews were conducted from Mar. 23 to May 27, 2021. Purposive and snowball sampling methods were used to recruit Asian Canadians diverse in region, gender and age. Interviews were conducted through Zoom videoconference or telephone, and independent qualitative thematic analysis in duplicate was used to derive primary themes and subthemes. RESULTS Thirty-two Asian Canadians (median age 35 [interquartile range 24-46] yr, 56% female, 44% East Asian) participated in the study. We identified 5 predominant themes associated with how the COVID-19 pandemic affected the participants' sense of security and belonging to their communities: relation between socioeconomic status (SES) and exposure to discrimination (i.e., how SES insulates or exposes individuals to increased discrimination); politics, media and the COVID-19 pandemic (i.e., the key role that politicians and media played in enabling spread of discrimination against and fear of Asian people); effect of discrimination on mental and social health (i.e., people's ability to interact and form meaningful relationships with others); coping with the impact of discrimination (i.e., the way people appraise and move forward in identity-threatening situations); and implications for sense of safety and sense of belonging (i.e., people feeling unable to safely use public spaces in person, including the need to remain alert in anticipation of harm, leading to distress and exhaustion). INTERPRETATION During the COVID-19 pandemic, Asian Canadians in our study felt unsafe owing to the uncertain, unexpected and unpredictable nature of discrimination, but also felt a strong sense of belonging to Canadian society and felt well connected to their Asian Canadian communities. Future work should seek to explore the influence of social media on treatment of and attitudes toward Asian Canadians.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Stephana Julia Moss
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Faizah Tiifu
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Emily FitzGerald
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Rebecca Brundin-Mathers
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Alexandra Dodds
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Amanpreet Brar
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Chloe Moira de Grood
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Henry T Stelfox
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Kirsten M Fiest
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
| | - Josh Ng-Kamstra
- School of Health Administration (Parsons Leigh, Moss, Tiifu, FitzGerald, Brundin-Mathers, De Grood), Faculty of Health, Dalhousie University, Halifax, NS; Department of Critical Care Medicine (Dodds, Stelfox, Fiest, Ng-Kamstra), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Surgery (Brar), University of Toronto, Toronto, Ont.; O'Brien Institute for Public Health (Stelfox), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Queen's Medical Center (Ng-Kamstra), Honolulu, HI; Department of Surgery (Ng-Kamstra), University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI
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Rosgen BK, Plotnikoff KM, Krewulak KD, Shahid A, Hernandez L, Sept BG, Morrissey J, Robertson K, Fraser N, Niven DJ, Straus SE, Leigh JP, Stelfox HT, Fiest KM. Co-development of a transitions in care bundle for patient transitions from the intensive care unit: a mixed-methods analysis of a stakeholder consensus meeting. BMC Health Serv Res 2022; 22:10. [PMID: 34974832 PMCID: PMC8722038 DOI: 10.1186/s12913-021-07392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community). Methods We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle. Results Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle. Conclusions Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07392-2.
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Affiliation(s)
- Brianna K Rosgen
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Laura Hernandez
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jeanna Morrissey
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kristin Robertson
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Nancy Fraser
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Sharon E Straus
- Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Jeanna Parsons Leigh
- Department of Medicine, School of Health Administration, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada.,O'Brien Institute for Public Health, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. .,Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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Parsons Leigh J, de Grood C, Brundin-Mather R, Dodds A, FitzGerald EA, Kemp L, Mizen SJ, Whalen-Browne L, Stelfox HT, Fiest KM. Identification and Assessment of Strategies to Address Gender Inequity in the Specialty of Critical Care Medicine: A Scoping Review, Modified Consensus Process, and Stakeholder Meeting. Crit Care Explor 2022; 4:e0612. [PMID: 35072079 PMCID: PMC8769084 DOI: 10.1097/cce.0000000000000612] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 11/26/2022] Open
Abstract
We sought to identify and prioritize improvement strategies that Critical Care Medicine (CCM) programs could use to inform and advance gender equity among physicians in CCM. DESIGN This study involved three sequential phases: 1) scoping review that identified strategies to improve gender equity in all medical specialties; 2) modified consensus process with 48 CCM stakeholders to rate and rank identified strategies; and 3) in-person stakeholder meeting to refine strategies and discuss facilitators and barriers to their implementation. SETTING CCM. SUBJECTS CCM stakeholders (physicians, researchers, and decision-makers; mutually inclusive). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified 190 unique strategies from 416 articles. Strategies were grouped thematically into 20 categories across four overarching pillars of equity: access, participation, reimbursement, and culture. Participants prioritized 22 improvement strategies for implementation in CCM. The top-rated strategy from each pillar included: 1) nominate gender diverse candidates for faculty positions and prestigious opportunities (equitable access); 2) mandate training in unconscious bias and equitable treatment for committee (e.g., hiring, promotion) members (equitable participation); 3) ensure equitable starting salaries regardless of sex or gender (equitable reimbursement); and, 4) conduct 360° evaluations of leaders (including their direct work circle of supervisors, peers, and subordinates) through a diversity lens (equitable culture). Interprofessional collaboration, leadership, and local champions were identified as key enablers for implementation. CONCLUSIONS We identified stakeholder-prioritized strategies that can be used to inform and enhance gender equity among physicians in CCM under four overarching equity pillars: access, participation, reimbursement, and culture. Implementation approaches should include education, policy creation, and measurement, and reporting.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chloe de Grood
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Alexandra Dodds
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Emily A FitzGerald
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Laryssa Kemp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Sara J Mizen
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Henry T Stelfox
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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34
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Mele BS, Holroyd-Leduc JM, Harasym P, Dumanski SM, Fiest K, Graham ID, Nerenberg K, Norris C, Parsons Leigh J, Pilote L, Pruden H, Raparelli V, Rabi D, Ruzycki SM, Somayaji R, Stelfox HT, Ahmed SB. Healthcare workers' perception of gender and work roles during the COVID-19 pandemic: a mixed-methods study. BMJ Open 2021; 11:e056434. [PMID: 35139035 PMCID: PMC8718936 DOI: 10.1136/bmjopen-2021-056434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES A high functioning healthcare workforce is a key priority during the COVID-19 pandemic. We sought to determine how work and mental health for healthcare workers changed during the COVID-19 pandemic in a universal healthcare system, stratified by gender factors. DESIGN A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey (7 May-15 July 2020). Phase 2 was semistructured interviews offered to all respondents upon survey completion to describe how experiences may have differed by gender identity, roles and relations. SETTING National universal healthcare system (Canada). PARTICIPANTS 2058 Canadian healthcare worker survey respondents (87% women, 11% men, 1% transgender or Two-Spirit), including 783 health professionals, 673 allied health professionals, 557 health support staff. Of the 63 unique healthcare worker types reported, registered nurses (11.5%), physicians (9.9%) and pharmacists (4.5%) were most common. Forty-six healthcare workers were interviewed. MAIN OUTCOME MEASURES Reported pandemic-induced changes to occupational leadership roles and responsibilities, household and caregiving responsibilities, and anxiety levels by gender identity. RESULTS Men (19.8%) were more likely to hold pandemic leadership roles compared with women (13.4%). Women (57.5%) were more likely to report increased domestic responsibilities than men (45%). Women and those with dependents under the age of 10 years reported the greatest levels of anxiety during the pandemic. Interviews with healthcare workers further revealed a perceived imbalance in leadership opportunities based on gender identity, a lack of workplace supports disproportionately affecting women and an increase in domestic responsibilities influenced by gender roles. CONCLUSIONS The COVID-19 pandemic response has important gendered effects on the healthcare workforce. Healthcare workers are central to effective pandemic control, highlighting an urgent need for a gender-transformative pandemic response strategy.
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Affiliation(s)
- Bria Scriven Mele
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Patricia Harasym
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ian D Graham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kara Nerenberg
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Louise Pilote
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Harlan Pruden
- Faculty of Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valeria Raparelli
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Doreen Rabi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
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Benham JL, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, Boucher JC, Constantinescu C, Parsons Leigh J, Ivers NM, Ratzan SC, Fullerton MM, Tang T, Manns BJ, Marshall DA, Hu J, Lang R. COVID-19 Vaccine-Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis. JMIR Public Health Surveill 2021; 7:e30424. [PMID: 34779784 PMCID: PMC8709417 DOI: 10.2196/30424] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations.
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Affiliation(s)
- Jamie L Benham
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Omid Atabati
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Robert J Oxoby
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | - Blake Shaffer
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean-Christophe Boucher
- School of Public Policy and Department of Political Sciences, University of Calgary, Calgary, AB, Canada
| | - Cora Constantinescu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Noah M Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Scott C Ratzan
- School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Madison M Fullerton
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Theresa Tang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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36
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Plotnikoff KM, Krewulak KD, Hernández L, Spence K, Foster N, Longmore S, Straus SE, Niven DJ, Parsons Leigh J, Stelfox HT, Fiest KM. Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care. Crit Care 2021; 25:438. [PMID: 34920729 PMCID: PMC8684123 DOI: 10.1186/s13054-021-03857-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? METHODS This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. RESULTS We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. CONCLUSIONS Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.
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Affiliation(s)
- Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Nadine Foster
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada
- Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Faculty of Health, School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College Street, Halifax, NS, B3H 4R2, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Psychiatry, Cumming School of Medicine, University of Calgary and Alberta Health Services, 3134 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Roberts DJ, Dreksler H, Nagpal SK, Li A, Parsons Leigh J, Brandys T, Jetty P, Dubois L, Stelfox HT, McIsaac DI. Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2021; 10:e32170. [PMID: 34507273 PMCID: PMC8665382 DOI: 10.2196/32170] [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: 07/16/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. OBJECTIVE The aim is to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, the seven databases in Evidence-Based Medicine Reviews, medRxiv, bioRxiv, and Google Scholar), review papers identified during the search, and included article bibliographies. We will include randomized and nonrandomized studies comparing the use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate the risk of bias. The primary outcome will be short-term (in-hospital or 30-day) mortality. Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, renal, and limb events; delirium; deep vein thrombosis or pulmonary embolism; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios (ORs) and standardized mean differences (SMDs) using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using the Begg and Egger tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to make an overall rating of the quality of evidence in our effect estimates. RESULTS The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We executed the peer-reviewed search strategy on March 2, 2021. We completed the review of titles and abstracts on July 30, 2021, and plan to complete the review of full-text papers by September 30, 2021. We will complete full-text study data extraction and the risk-of-bias assessment by November 15, 2021, and conduct qualitative and then quantitative data synthesis and GRADE assessment of results by January 1, 2022, before drafting the manuscript. We anticipate that we will be able to submit the manuscript for peer review by the end of February 2022. CONCLUSIONS This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. TRIAL REGISTRATION Prospero CRD42021237060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=237060. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32170.
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Affiliation(s)
- Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada
| | - Hannah Dreksler
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Allen Li
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Timothy Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Prasad Jetty
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
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Lang R, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, Fullerton MM, Tang T, Leigh JP, Manns BJ, Marshall DA, Ivers NM, Ratzan SC, Hu J, Benham JL. Characterization of non-adopters of COVID-19 non-pharmaceutical interventions through a national cross-sectional survey to assess attitudes and behaviours. Sci Rep 2021; 11:21751. [PMID: 34741109 PMCID: PMC8571421 DOI: 10.1038/s41598-021-01279-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/25/2021] [Indexed: 01/27/2023] Open
Abstract
Adoption of non-pharmaceutical interventions (NPIs) remains critical to curtail the spread of COVID-19. Using self-reported adherence to NPIs in Canada, assessed through a national cross-sectional survey of 4498 respondents, we aimed to identify and characterize non-adopters of NPIs, evaluating their attitudes and behaviours to understand barriers and facilitators of adoption. A cluster analysis was used to group adopters separately from non-adopters of NPIs. Associations with sociodemographic factors, attitudes towards COVID-19 and the public health response were assessed using logistic regression models comparing non-adopters to adopters. Of the 4498 respondents, 994 (22%) were clustered as non-adopters. Sociodemographic factors significantly associated with the non-adoption cluster were: (1) being male, (2) age 18–34 years, (3) Albertans, (4) lower education level and (5) higher conservative political leaning. Participants who expressed low concern for COVID-19 and distrust towards several institutions had greater odds of being non-adopters. This information characterizes individuals at greatest odds for non-adoption of NPIs to inform targeted marketing interventions.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Omid Atabati
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Robert J Oxoby
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | - Blake Shaffer
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Madison M Fullerton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theresa Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah M Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Scott C Ratzan
- City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Jia Hu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Fiest KM, Krewulak KD, Makuk K, Jaworska N, Hernández L, Bagshaw SM, Burns KE, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler RA, Kho ME, Parhar KKS, Rewa OG, Rochwerg B, Sept BG, Soo A, Spence S, West A, Stelfox HT, Parsons Leigh J. A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2021; 3:e0562. [PMID: 34712955 PMCID: PMC8547909 DOI: 10.1097/cce.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics. DESIGN Three rounds of a remote modified Delphi consensus process. SETTING Online survey and virtual polling from February 2, 2021, to April 8, 2021. SUBJECTS Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic. MEASUREMENTS AND MAIN RESULTS During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies. CONCLUSIONS We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Karen E Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
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Shahid A, Rosgen BK, Krewulak KD, Lorenzetti DL, Foster N, Sept BG, Leigh JP, Stelfox HT, Fiest KM. Incorporating and evaluating citizen engagement in health research: a scoping review protocol. Syst Rev 2021; 10:260. [PMID: 34583771 PMCID: PMC8480041 DOI: 10.1186/s13643-021-01812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Citizen engagement in research is an emerging practice that involves members of the general public in research processes such as priority setting, planning, decision-making, research conduct, implementation, evaluation, and dissemination. Engaging citizens in research, particularly health research, increases the relevance of study findings, minimizes waste by facilitating stewardship over resources, and builds public trust in the research. While several existing frameworks guide the application of citizen engagement principles to health research, it is unclear how citizen engagement can be utilized to maximize benefits and minimize risks and challenges in health research. To address the gaps in knowledge around citizen engagement in health research, we propose a scoping review to synthesize the state of knowledge on methods to incorporate and evaluate citizen engagement in research. A protocol is presented in this manuscript. METHODS The methodology for our scoping review is guided by Arksey and O' Malley's framework for scoping reviews, and additional recommendations by Levac and colleagues. We will include peer-reviewed and gray literature that report on citizen engagement in health research (including biomedical, clinical, health systems and services, and social, cultural, environmental and population health) and report method(s) to conduct, measure, or evaluate citizen engagement. We will systematically search electronic databases (MEDLINE, EMBASE, CINAHL, JSTOR, PsycINFO, Scopus, and Science Direct) from inception onwards and search relevant organizations' websites for additional studies, frameworks, and reports on citizen engagement. Title and abstract and full-text citations will be screened independently and in duplicate. Data will be extracted independently and in duplicate, including document characteristics, citizen engagement definitions and goals, and outcomes of citizen engagement (e.g., barriers, facilitators). DISCUSSION This review will synthesize the definitions, goals, methods, outcomes, and significance of citizen engagement in health research, as well as any potential barriers, facilitators, and challenges outlined in existing literature. The findings will provide an evidence-based foundation for developing new or improved guidance for citizen engagement in health research. Overall, we anticipate that our scoping review will be a preliminary step to meaningful engagement of citizens in research and strengthen the relationship between the scientific community and the public through transparency and collaboration. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/hzcbr .
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Diane L Lorenzetti
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Foster
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada. .,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler R, Hernández L, Kho ME, Kredentser M, Makuk K, Murthy S, Niven DJ, Olafson K, Parhar KKS, Patten SB, Rewa OG, Rochwerg B, Sept B, Soo A, Spence K, Spence S, Straus S, West A, Parsons Leigh J, Fiest KM. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. Crit Care 2021; 25:347. [PMID: 34563234 PMCID: PMC8465762 DOI: 10.1186/s13054-021-03763-7] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals.
Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03763-7.
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Affiliation(s)
- Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie C Anglin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kendiss Olafson
- Department of Medicine, University of Manitoba, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Chinook Regional Hospital, Lethbridge County, Alberta, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Moss SJ, Stelfox HT, Krewulak KD, Ahmed S, Anglin MC, Bagshaw SM, Barnes T, Burns KEA, Cook DJ, Crowe S, Doig CJ, Foster N, Fox-Robichaud A, Fowler R, Kredenster M, Murthy S, Niven D, Olafson K, Parhar KKS, Patten SB, Rewa O, Rochwerg B, Sept BG, Soo A, Spence K, Spence S, Straus SE, West A, Parsons Leigh J, Fiest KM. Impact of restricted visitation policies in hospitals on patients, family members and healthcare providers during the COVID-19 pandemic: a scoping review protocol. BMJ Open 2021; 11:e048227. [PMID: 34556510 PMCID: PMC8461363 DOI: 10.1136/bmjopen-2020-048227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Flexible visitation policies in hospitals are an important component of care that contributes to reduced stress and increased satisfaction among patients and their family members. Early evidence suggests restricted visitation policies enacted in hospitals during the COVID-19 pandemic are having unintended consequences on patients, family members and healthcare providers. There is a need for a comprehensive summary of the impacts of restricted visitation policies on key stakeholders and approaches to mitigate that impact. METHODS AND ANALYSIS We will conduct a scoping review as per the Arksey-O'Malley 5-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. We will search relevant electronic databases (eg, CINAHL, MEDLINE, PsycINFO), grey literature and preprint repositories. We will include all study designs including qualitative and quantitative methodologies (excluding protocols) as well as reports, opinions and editorials, to identify the broad impact of restricted hospital visitation policies due to the COVID-19 pandemic on patients, family members or healthcare providers of hospitalised patients, and approaches taken or proposed to mitigate this impact. Two reviewers will calibrate the screening criteria and data abstraction form and will independently screen studies and abstract the data. Narrative synthesis with thematic analysis will be performed. ETHICS AND DISSEMINATION Ethical approval is not applicable as this review will be conducted on published literature only. This scoping review will identify, describe and categorise impacts of restricted hospital visitation policies due to the COVID-19 pandemic on patients, family members and healthcare providers of hospitalised patients, and approaches that have been taken to mitigate impact. We will provide a comprehensive synthesis by developing a framework of restricted visitation policies and associated impacts. Our results will inform the development of consensus statements on restricted visitation policies to be implemented in future pandemics. PROSPERO REGISTRATION NUMBER CRD42020221662.
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Affiliation(s)
- Stephana J Moss
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karla D Krewulak
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sofia Ahmed
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Melanie C Anglin
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Tavish Barnes
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen E A Burns
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Deborah J Cook
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Crowe
- Nurse Practitioners, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Christopher J Doig
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nadine Foster
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Robert Fowler
- Sunnybrook Health Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Maia Kredenster
- Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Srinivas Murthy
- Departments of Pediatrics and Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Niven
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kendiss Olafson
- Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Scott B Patten
- Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Oleska Rewa
- Critical Care Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Bram Rochwerg
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bonnie G Sept
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Krista Spence
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean Spence
- Critical Care Medicine, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew West
- Respiratory Therapy, Canadian Society of Respiratory Therapists, Saint John, New Brunswick, Canada
| | - Jeanna Parsons Leigh
- Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kirsten M Fiest
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Tricco AC, Lachance CC, Rios P, Darvesh N, Antony J, Radhakrishnan A, Anand SS, Baxter N, Burns KEA, Coyle D, Curran JA, Fiest K, Graham ID, Hawker G, Légaré F, Watt J, Witteman HO, Clark JP, Bourgeault IL, Leigh JP, Ahmed SB, Lawford K, Aiken A, Falk-Krzesinski HJ, Langlois EV, McCabe C, Shepperd S, Skidmore B, Pattani R, Leon N, Lundine J, Adisso L, El-Adhami W, Straus SE. Global evidence of gender inequity in academic health research: a living scoping review protocol. JBI Evid Synth 2021; 18:2181-2193. [PMID: 32925395 DOI: 10.11124/jbies-20-00078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this review is to describe the global evidence of gender inequity among individuals with appointments at academic institutions that conduct health research, and examine how gender intersects with other social identities to influence outcomes. INTRODUCTION The gender demographics of universities have shifted, yet the characteristics of those who lead academic health research institutions have not reflected this change. Synthesized evidence will guide decision-making and policy development to support the progress of gender and other under-represented social identities in academia. INCLUSION CRITERIA This review will consider any quantitative, qualitative, or mixed methods primary research that reports outcome data related to gender equity and other social identities among individuals affiliated with academic or research institutions that conduct health research, originating from any country. METHODS The JBI Manual for Evidence Synthesis and the Cochrane Collaboration's guidance on living reviews will inform the review methods. Information sources will include electronic databases, unpublished literature sources, reference scanning of relevant systematic reviews, and sources provided by experts on the research team. Searches will be run regularly to monitor the development of new literature and determine when the review will be updated. Study selection and data extraction will be conducted by two reviewers working independently, and all discrepancies will be resolved by discussion or a third reviewer. Data synthesis will summarize information using descriptive frequencies and simple thematic analysis. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension to scoping reviews. REGISTRATION Open Science Framework: https://osf.io/8wk7e/.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | | | - Patricia Rios
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nazia Darvesh
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Amruta Radhakrishnan
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sonia S Anand
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nancy Baxter
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten Fiest
- Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Office of Education and Professional Development, Université Laval, Quebec City, QC, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,The Lancet, London, ON, United Kingdom
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Lawford
- Department of Gender Studies, Queen's University, Haudenosaunee and Anishinaabek Territories, Settlement of Kingston, ON, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, NS, Canada
| | - Holly J Falk-Krzesinski
- Global Strategic Networks, Elsevier Incorporated, New York City, NY, USA.,School of Professional Studies, Northwestern University, Chicago, IL, USA
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Chris McCabe
- Institute of Health Economics, Edmonton, AB, Canada
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Reena Pattani
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Internal Medicine, Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity, Acton, ACT, Australia
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Parsons Leigh J, Kemp LG, de Grood C, Brundin-Mather R, Stelfox HT, Ng-Kamstra JS, Fiest KM. A qualitative study of physician perceptions and experiences of caring for critically ill patients in the context of resource strain during the first wave of the COVID-19 pandemic. BMC Health Serv Res 2021; 21:374. [PMID: 33888096 PMCID: PMC8061878 DOI: 10.1186/s12913-021-06393-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic has led to global shortages in the resources required to care for critically ill patients and to protect frontline healthcare providers. This study investigated physicians’ perceptions and experiences of caring for critically ill patients in the context of actual or anticipated resource strain during the COVID-19 pandemic, and explored implications for the healthcare workforce and the delivery of patient care. Methods We recruited a diverse sample of critical care physicians from 13 Canadian Universities with adult critical care training programs. We conducted semi-structured telephone interviews between March 25–June 25, 2020 and used qualitative thematic analysis to derive primary themes and subthemes. Results Fifteen participants (eight female, seven male; median age = 40) from 14 different intensive care units described three overarching themes related to physicians’ perceptions and experiences of caring for critically ill patients during the pandemic: 1) Conditions contributing to resource strain (e.g., continuously evolving pandemic conditions); 2) Implications of resource strain on critical care physicians personally (e.g., safety concerns) and professionally (e.g. practice change); and 3) Enablers of resource sufficiency (e.g., adequate human resources). Conclusions The COVID-19 pandemic has required health systems and healthcare providers to continuously adapt to rapidly evolving circumstances. Participants’ uncertainty about whether their unit’s planning and resources would be sufficient to ensure the delivery of high quality patient care throughout the pandemic, coupled with fear and anxiety over personal and familial transmission, indicate the need for a unified systemic pandemic response plan for future infectious disease outbreaks. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06393-5.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada. .,Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
| | - Laryssa G Kemp
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chloe de Grood
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Josh S Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Parsons Leigh J, Krewulak KD, Zepeda N, Farrier CE, Spence KL, Davidson JE, Stelfox HT, Fiest KM. Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study. Can J Anaesth 2021; 68:358-366. [PMID: 33210217 PMCID: PMC7902561 DOI: 10.1007/s12630-020-01866-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care. METHODS In this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta. RESULTS Key themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU) care team may not use a family member's results, intensification of work load), 2) considerations regarding feasibility (e.g., insufficient knowledge, healthcare team buy-in), and 3) overarching strategies to support implementation into routine patient care (e.g., value of family-administered delirium detection for patients and families is well understood in the clinical context, regular communication between the family and ICU providers, an electronic version of the tool). CONCLUSIONS Patients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT03379129); registered 15 December 2017.
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Affiliation(s)
- Jeanna Parsons Leigh
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Nubia Zepeda
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Christian E Farrier
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Judy E Davidson
- Department of Education, Development and Research, University of California, San Diego Health, San Diego, CA, USA
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
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Fiest KM, Parsons Leigh J, Krewulak KD, Plotnikoff KM, Kemp LG, Ng-Kamstra J, Stelfox HT. Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review. BMC Psychiatry 2021; 21:91. [PMID: 33568141 PMCID: PMC7875435 DOI: 10.1186/s12888-021-03090-9] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health. METHODS We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers. RESULTS From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms. INTERPRETATION Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada.
| | - Jeanna Parsons Leigh
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
- School of Health Administration, Faculty of Health and Department of Critical Care Medicine, Faculty of Medicine, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H4R2, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Laryssa G Kemp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Joshua Ng-Kamstra
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
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Parsons Leigh J, Brundin-Mather R, Whalen-Browne L, Kashyap D, Sauro K, Soo A, Petersen J, Taljaard M, Stelfox HT. Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial. JMIR Res Protoc 2021; 10:e18675. [PMID: 33416509 PMCID: PMC7822720 DOI: 10.2196/18675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Transitions in care are vulnerable periods in health care that can expose patients to preventable errors due to incomplete or delayed communication between health care providers. Transitioning critically ill patients from intensive care units (ICUs) to other patient care units (PCUs) is particularly risky, due to the high acuity of the patients and the diversity of health care providers involved in their care. Instituting structured documentation to standardize written communication between health care providers during transitions has been identified as a promising means to reduce communication breakdowns. We developed an evidence-informed, computer-enabled, ICU-specific structured tool-an electronic transfer (e-transfer) tool-to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city. The tool consisted of 10 primary sections with a user interface combination of structured, automated, and free-text fields. OBJECTIVE Our overarching goal is to evaluate whether implementation of our e-transfer tool will improve the completeness and timeliness of transfer summaries and streamline communications between health care providers during high-risk transitions. METHODS This study is a cluster-specific pre-post trial, with randomized and staggered implementation of the e-transfer tool in four hospitals in Calgary, Alberta. Hospitals (ie, clusters) were allocated randomly to cross over every 2 months from control (ie, dictation only) to intervention (ie, e-transfer tool). Implementation at each site was facilitated with user education, point-of-care support, and audit and feedback. We will compare transfer summaries randomly sampled over 6 months postimplementation to summaries randomly sampled over 6 months preimplementation. The primary outcome will be a binary composite measure of the timeliness and completeness of transfer summaries. Secondary measures will include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes, including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality. We will use descriptive statistics (ie, medians and means) to describe demographic characteristics. The primary outcome will be compared within each hospital pre- and postimplementation using separate logistic regression models for each hospital, with adjustment for patient characteristics. RESULTS Participating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Preliminary extraction of ICU patient admission lists was completed in September 2019. We anticipate that evaluation data collection will be completed by early 2021, with first results ready for publication in spring or summer 2021. CONCLUSIONS This study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units. TRIAL REGISTRATION ClinicalTrials.gov NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18675.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Devika Kashyap
- Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Khara Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Arnie Charbonneau Cancer Institute, Health Research Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Jennie Petersen
- Faculty of Applied Health Sciences, Brock University, St Catharines, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Fiest KM, Krewulak KD, Plotnikoff KM, Kemp LG, Parhar KKS, Niven DJ, Kortbeek JB, Stelfox HT, Parsons Leigh J. Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice. BMC Med 2020; 18:404. [PMID: 33334347 PMCID: PMC7746486 DOI: 10.1186/s12916-020-01871-9] [Citation(s) in RCA: 5] [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: 09/23/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks. METHODS We conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design. RESULTS From 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason. CONCLUSIONS This review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Laryssa G Kemp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - John B Kortbeek
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Anaesthesia, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H4R2, Canada.
- Department of Critical Care Medicine, Faculty of Medicine, Dalhousie University, 6299 South St, Halifax, Nova Scotia, B3H4R2, Canada.
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Ng-Kamstra J, Stelfox HT, Fiest K, Conly J, Leigh JP. Perspectives sur l’équipement de protection individuelle dans les établissements de soins actifs durant la pandémie de COVID-19. CMAJ 2020; 192:E1785-E1790. [DOI: 10.1503/cmaj.200575-f] [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: 11/01/2022] Open
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Affiliation(s)
| | - Tom Stelfox
- Professor and head, University of Calgary, Calgary, Alta
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