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Wahl KJ, Brooks M, Trenaman L, Desjardins-Lorimer K, Bell CM, Chokmorova N, Segall R, Syring J, Williams A, Li LC, Norman WV, Munro S. User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study. J Med Internet Res 2024; 26:e48793. [PMID: 38625731 PMCID: PMC11061794 DOI: 10.2196/48793] [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: 05/07/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. OBJECTIVE We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. METHODS We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. RESULTS A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. CONCLUSIONS We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.
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Affiliation(s)
- Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | | | - Carolyn M Bell
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Nazgul Chokmorova
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Romy Segall
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Janelle Syring
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Islam A, Munro S, Hassan MM, Epstein JH, Klaassen M. The role of vaccination and environmental factors on outbreaks of high pathogenicity avian influenza H5N1 in Bangladesh. One Health 2023; 17:100655. [PMID: 38116452 PMCID: PMC10728328 DOI: 10.1016/j.onehlt.2023.100655] [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: 09/30/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
High Pathogenicity Avian Influenza (HPAI) H5N1 outbreaks continue to wreak havoc on the global poultry industry and threaten the health of wild bird populations, with sporadic spillover in humans and other mammals, resulting in widespread calls to vaccinate poultry. Bangladesh has been vaccinating poultry since 2012, presenting a prime opportunity to study the effects of vaccination on HPAI H5N1circulation in both poultry and wild birds. We investigated the efficacy of vaccinating commercial poultry against HPAI H5N1 along with climatic and socio-economic factors considered potential drivers of HPAI H5N1 outbreak risk in Bangladesh. Using a multivariate modeling approach, we estimated that the rate of outbreaks was 18 times higher before compared to after vaccination, with winter months having a three times higher chance of outbreaks than summer months. Variables resulting in small but significant increases in outbreak rate were relatively low ambient temperatures for the time of year, literacy rate, chicken and duck density, crop density, and presence of highways; this may be attributable to low temperatures supporting viral survival outside the host, higher literacy driving reporting rate, density of the host reservoir, and spread of the virus through increased connectivity. Despite the substantial impact of vaccination on outbreaks, we note that HPAI H5N1 is still enzootic in Bangladesh; vaccinated poultry flocks have high rates of H5N1 prevalence, and spillover to wild birds has increased. Vaccination in Bangladesh thus bears the risk of supporting "silent spread," where the vaccine only provides protection against disease and not also infection. Our findings underscore that poultry vaccination can be part of holistic HPAI mitigation strategies when accompanied by monitoring to avoid silent spread.
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Affiliation(s)
- Ariful Islam
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, Victoria, Australia
- EcoHealth Alliance, New York, NY 10018, USA
| | | | - Mohammad Mahmudul Hassan
- Queensland Alliance for One Health Sciences, School of Veterinary Science, University of Queensland, Brisbane, QLD, Australia
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | | | - Marcel Klaassen
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, Victoria, Australia
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Islam A, Amin E, Munro S, Hossain ME, Islam S, Hassan MM, Al Mamun A, Samad MA, Shirin T, Rahman MZ, Epstein JH. Potential risk zones and climatic factors influencing the occurrence and persistence of avian influenza viruses in the environment of live bird markets in Bangladesh. One Health 2023; 17:100644. [PMID: 38024265 PMCID: PMC10665157 DOI: 10.1016/j.onehlt.2023.100644] [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: 06/18/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Live bird markets (LBMs) are critical for poultry trade in many developing countries that are regarded as hotspots for the prevalence and contamination of avian influenza viruses (AIV). Therefore, we conducted weekly longitudinal environmental surveillance in LBMs to determine annual cyclic patterns of AIV subtypes, environmental risk zones, and the role of climatic factors on the AIV presence and persistence in the environment of LBM in Bangladesh. From January 2018 to March 2020, we collected weekly fecal and offal swab samples from each LBM and tested using rRT-PCR for the M gene and subtyped for H5, H7, and H9. We used Generalized Estimating Equations (GEE) approaches to account for repeated observations over time to correlate the AIV prevalence and potential risk factors and the negative binomial and Poisson model to investigate the role of climatic factors on environmental contamination of AIV at the LBM. Over the study period, 37.8% of samples tested AIV positive, 18.8% for A/H5, and A/H9 was, for 15.4%. We found the circulation of H5, H9, and co-circulation of H5 and H9 in the environmental surfaces year-round. The Generalized Estimating Equations (GEE) model reveals a distinct seasonal pattern in transmitting AIV and H5. Specifically, certain summer months exhibited a substantial reduction of risk up to 70-90% and 93-94% for AIV and H5 contamination, respectively. The slaughtering zone showed a significantly higher risk of contamination with H5, with a three-fold increase in risk compared to bird-holding zones. From the negative binomial model, we found that climatic factors like temperature and relative humidity were also significantly associated with weekly AIV circulation. An increase in temperature and relative humidity decreases the risk of AIV circulation. Our study underscores the significance of longitudinal environmental surveillance for identifying potential risk zones to detect H5 and H9 virus co-circulation and seasonal transmission, as well as the imperative for immediate interventions to reduce AIV at LBMs in Bangladesh. We recommend adopting a One Health approach to integrated AIV surveillance across animal, human, and environmental interfaces in order to prevent the epidemic and pandemic of AIV.
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Affiliation(s)
- Ariful Islam
- EcoHealth Alliance, New York, NY 10018, USA
- School of Life and Environmental Sciences, Deakin University, Geelong, Victoria, Australia
| | - Emama Amin
- EcoHealth Alliance, New York, NY 10018, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
| | | | - Mohammad Enayet Hossain
- One Health Laboratory, International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR), Bangladesh
| | - Shariful Islam
- EcoHealth Alliance, New York, NY 10018, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
| | - Mohammad Mahmudul Hassan
- Queensland Alliance for One Health Sciences, School of Veterinary Science, University of Queensland, QLD 4343, Australia
| | - Abdullah Al Mamun
- EcoHealth Alliance, New York, NY 10018, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
| | - Mohammed Abdus Samad
- National Reference Laboratory for Avian Influenza, Bangladesh Livestock Research Institute (BLRI), Savar, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
| | - Mohammed Ziaur Rahman
- One Health Laboratory, International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR), Bangladesh
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Wahl K, Norman WV, Van Esch K, Williams A, Wylie A, Munro S. The Medical Abortion Prescriber Checklist and Resource Guide: Tools for Prescribers. J Obstet Gynaecol Can 2023; 45:102135. [PMID: 37201581 DOI: 10.1016/j.jogc.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Kate Wahl
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BCWomen's Hospital and Health Centre, Vancouver, BC
| | - Wendy V Norman
- Contraception and Abortion Research Team, Women's Health Research Institute, BCWomen's Hospital and Health Centre, Vancouver, BC; Department of Family Practice, The University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristen Van Esch
- Contraception and Abortion Research Team, Women's Health Research Institute, BCWomen's Hospital and Health Centre, Vancouver, BC; Department of Family Practice, The University of British Columbia, Vancouver, BC
| | - Aleyah Williams
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BCWomen's Hospital and Health Centre, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, BC
| | | | - Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BCWomen's Hospital and Health Centre, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, BC.
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Trenaman L, Kaal KJ, Laba TL, Safari A, Aguiar M, Burch T, Beckett J, Munro S, Hudson M, Harrison M. The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey. CMAJ Open 2023; 11:E630-E636. [PMID: 37437955 PMCID: PMC10356003 DOI: 10.9778/cmajo.20220227] [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: 07/14/2023] Open
Abstract
BACKGROUND Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities. METHODS We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins. RESULTS The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458). INTERPRETATION Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - K Julia Kaal
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tracey-Lea Laba
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Abdollah Safari
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Magda Aguiar
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tiasha Burch
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Jennifer Beckett
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Marie Hudson
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
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Zusman EZ, Munro S, Norman WV, Soon JA. Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year. Can Pharm J (Ott) 2023; 156:204-214. [PMID: 37435503 PMCID: PMC10331362 DOI: 10.1177/17151635231176270] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 07/13/2023]
Abstract
Background Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. Methods From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Results Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Interpretation Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Conclusions Mifepristone is well accepted by pharmacists within the primary care system in Canada.
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Affiliation(s)
- Enav Z. Zusman
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research, Vancouver, British Columbia
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver
| | - Judith A. Soon
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Family Practice, University of British Columbia, Vancouver
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ennis M, Olure B, Norman WV, Begun S, Martin L, Harris LH, Kean L, Seewald M, Munro S. Experience of stigma and harassment among respondents to the 2019 Canadian abortion provider survey. Contraception 2023:110083. [PMID: 37263373 DOI: 10.1016/j.contraception.2023.110083] [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: 02/03/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We conducted a national survey to assess the experiences of stigma and harassment among physicians and nurse practitioners providing abortions and abortion service administrators in Canada. STUDY DESIGN We conducted an exploratory, cross-sectional, national, anonymized, online survey between July and December 2020. Subsections of the survey explored stigma and harassment experienced by respondents, including the 35-item Revised Abortion Providers Stigma Scale and open-ended responses. We analyzed the quantitative data to generate descriptive statistics and employed a reflexive thematic analysis to interpret open-ended responses. RESULTS Three hundred fifty-four participants started the stigma and harassment section of the survey. Among low-volume clinicians (<30 abortions/year, 60%, n=180) 8% reported harassment; 21% among higher volume clinicians (≥30 abortions/year, 40%, n=119) and 47% among administrators (n=39), most commonly picketing. The mean stigma score was 67.8 (standard deviation 17.2; maximum score 175). Our qualitative analysis identified five themes characterizing perceptions of stigma and harassment: concerns related to harassment from picketing, protestors, and the public; wanting protestor 'bubble zones'; aiming to be anonymous to avoid being a target; not providing an abortion service; but also witnessing a safe and positive practice environment. CONCLUSION Being a low-volume clinician compared to higher volume clinician and administrator appears to be associated with less harassment. Clinicians providing abortion care in Canada reported mid-range abortion-related stigma scores, and expressed strong concerns that stigma interfered with their abortion provision. Our results indicate that further de-stigmatization and protection of abortion providers in Canada is needed through policy and practice interventions including bubble zones. IMPLICATIONS While Canadian abortion care clinicians and administrators reported relatively low incidence of harassment, our results indicate that they are concerned about stigma and harassment. However, as this was an exploratory survey, these data may not be representative of all Canadian abortion providers. Our data identify a need to support abortion clinicians and to bolster protections for dedicated abortion services.
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Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Bimbola Olure
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital Vancouver, B.C
| | - Wendy V Norman
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; Department of Family Practice, University of British Columbia. Vancouver, BC; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Lisa Martin
- Department of Health and Human Services, University of Michigan-Dearborn, Dearborn, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Lauren Kean
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meghan Seewald
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital Vancouver, B.C
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Smith DM, Sales J, Williams A, Munro S. Pregnancy intentions of young women in Canada in the era of climate change: a qualitative auto-photography study. BMC Public Health 2023; 23:766. [PMID: 37098525 PMCID: PMC10127979 DOI: 10.1186/s12889-023-15674-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Climate change poses a global health risk through consequences such as sea level rise, wildfires, and increased air pollution. Children born today and in the future may be disproportionately affected by climate change. As a result, many young adults are rethinking having children. The impacts of the climate crisis on the decision-making of parents is an understudied area of research. This study aims to be one of the first to explore how climate change impacts the pregnancy intentions of young women in Canada and their perspectives towards childbearing. METHODS We conducted auto-photography and qualitative interviews. Participants were recruited using social media, and were aged 18-25, nulliparous, assigned female at birth, and were either current or previous residents of British Columbia, Canada. We asked participants to take photos that responded to the question, "Show us how climate change impacts your decision to have a family," then complete a virtual, one-on-one interview during which photo-elicitation was employed to guide conversation about participants' decision-making related to childbearing and climate change. We subjected all transcribed interviews to qualitative thematic analysis. RESULTS We conducted in-depth interviews with seven participants who discussed a total of 33 photographs. Analysis of participants' interviews and photographs identified themes of eco-anxiety, hesitancy towards having children, sense of loss, and a desire for systemic change. Participants experienced anxiety, grief, and loss when faced with thoughts of change associated with their environments. Climate change impacted all but two participants' childbearing decision making, which was found to be interrelated with social-environmental factors, such as cost of living. CONCLUSION We aimed to identify the ways in which climate change may impact youth decisions to have a family. Further research on this topic is needed to understand the prevalence of this phenomenon, and to build such considerations into climate action policy and family planning tools used among young people.
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Affiliation(s)
- Danielle M Smith
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Javier Sales
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Meherali S, Munro S, Puinean G, Salami B, Wong JPH, Vandermorris A, Benoit JRA, Flicker S, Okeke-Ihejirika P, Stroulia E, Norman WV, Scott SD. Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study. JMIR Res Protoc 2023; 12:e45389. [PMID: 36947124 PMCID: PMC10131995 DOI: 10.2196/45389] [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: 12/28/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45389.
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Affiliation(s)
| | - Sarah Munro
- University of British Columbia, Vancouver, BC, Canada
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Munro S, Di Meglio G, Williams A, Barbic SP, Begun S, Black A, Carson A, Fortin M, Jacob K, Khan Z, Martin-Misener R, Meherali S, Paller V, Seiyad H, Vallée CA, Wahl K, Norman WV. Can youth-engaged research facilitate equitable access to contraception in Canada? The qualitative study protocol for the Ask Us project. BMJ Open 2023; 13:e070904. [PMID: 36863736 PMCID: PMC9990688 DOI: 10.1136/bmjopen-2022-070904] [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] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. METHODS AND ANALYSIS This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. ETHICS AND DISSEMINATION Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppina Di Meglio
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Black
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Carson
- Research, Innovation, and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Michelle Fortin
- Options for Sexual Health, Vancouver, British Columbia, Canada
| | - Kaiya Jacob
- Youth Partner, Vancouver, British Columbia, Canada
| | - Zeba Khan
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Victoria Paller
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Carol-Anne Vallée
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Carson A, Cameron ES, Paynter M, Norman WV, Munro S, Martin-Misener R. Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach. J Adv Nurs 2023; 79:686-697. [PMID: 36369652 PMCID: PMC10100085 DOI: 10.1111/jan.15487] [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: 05/25/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
AIMS To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. DESIGN A qualitative approach informed by feminist theory and integrated knowledge translation. METHODS Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. RESULTS Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. CONCLUSION When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. IMPACT The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. PATIENT OR PUBLIC CONTRIBUTION This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.
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Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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Paynter M, Pinzón Hernández P, Heggie C, McKibbon S, Munro S. Abortion and contraception for incarcerated people: A scoping review. PLoS One 2023; 18:e0281481. [PMID: 36996087 PMCID: PMC10062621 DOI: 10.1371/journal.pone.0281481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Women experiencing incarceration have higher rates of unmet contraceptive needs and rates of abortion than the public. Incarceration presents multiple potential barriers to accessing abortion and contraception care, including prison security protocols, prison locations, lack of access to care providers, stigma, and low health literacy. The objective of this scoping review is to understand the extent and type of evidence in relation to contraception and abortion access for people experiencing criminalization and incarceration. METHODS We used the Joanna Briggs Institute methodology for scoping reviews and include empirical research with people experiencing criminalization or incarceration and/or with prison staff; with respect to prescription contraception or abortion access, while in custody or after having experienced incarceration/criminalization. Databases searched include CINAHL, APA PsycInfo, Gender Studies, Medline (Ovid), Embase, Sociological Abstracts, and Social Services Abstracts. The search yielded 6096 titles of which 43 were included in the review. RESULTS Our search yielded 43 studies published between 2001 and 2021 across six countries. The studies included qualitative, quantitative, and mixed methods designs. The main outcomes of interest included contraceptive use; attitudes towards abortion, contraception, and pregnancy; and barriers to care. Barriers identified included lack of onsite access to options, contraceptive coercion by providers, financial costs, and disruptions to medical coverage and insurance status which incarcerated. DISCUSSION Evidence indicates that people in prison face significant barriers to maintaining continuity of contraceptive methods, abortion access, and reproductive health guidance. Some studies articulated participants felt judged when discussing contraception with prison-based health care providers. Geographic location, out-of-pocket payments, and trust in health care providers were reported as barriers to access. CONCLUSION Incarceration presents considerable challenges to the access of contraception and abortion care. Future research should examine the interaction between institutional security policies and procedures on care seeking, the experiences of underserved and hyper-incarcerated groups, and the impact of being denied access to contraception and abortion and experiences of criminalization.
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Affiliation(s)
- Martha Paynter
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Paula Pinzón Hernández
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Shelley McKibbon
- WK Kellogg Health Sciences Library, Dalhousie University Libraries, Halifax, Nova Scotia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
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Islam A, Islam S, Islam M, Hossain ME, Munro S, Samad MA, Rahman MK, Shirin T, Flora MS, Hassan MM, Rahman MZ, Epstein JH. Prevalence and risk factors for avian influenza virus (H5 and H9) contamination in peri-urban and rural live bird markets in Bangladesh. Front Public Health 2023; 11:1148994. [PMID: 37151580 PMCID: PMC10158979 DOI: 10.3389/fpubh.2023.1148994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Avian influenza viruses (AIV) have been frequently detected in live bird markets (LBMs) around the world, primarily in urban areas, and have the ability to spillover to other species, including humans. Despite frequent detection of AIV in urban LBMs, the contamination of AIV on environmental surfaces in rural and peri-urban LBMs in Bangladesh is poorly documented. Therefore, we conducted this study to determine the prevalence of AIV subtypes within a subset of peri-urban and rural LBMs in Bangladesh and to further identify associated risk factors. Between 2017 and 2018, we collected faecal and offal samples from 200 stalls in 63 LBMs across four sub-districts. We tested the samples for the AIV matrix gene (M-gene) followed by H5, H7, and H9 subtypes using real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). We performed a descriptive analysis of market cleanliness and sanitation practices in order to further elucidate the relationship between LBM biosecurity and AIV subtypes by species, sample types, and landscape. Subsequently, we conducted a univariate analysis and a generalized linear mixed model (GLMM) to determine the risk factors associated with AIV contamination at individual stalls within LBMs. Our findings indicate that practices related to hygiene and the circulation of AIV significantly differed between rural and peri-urban live bird markets. 42.5% (95% CI: 35.56-49.67) of stalls were positive for AIV. A/H5, A/H9, and A HA/Untyped were detected in 10.5% (95% CI: 6.62-15.60), 9% (95% CI: 5.42-13.85), and 24.0% (95% CI: 18.26-30.53) of stalls respectively, with no detection of A/H7. Significantly higher levels of AIV were found in the Sonali chicken strain compared to the exotic broiler, and in offal samples compared to fecal samples. In the GLMM analysis, we identified several significant risk factors associated with AIV contamination in LBMs at the stall level. These include: landscape (AOR: 3.02; 95% CI: 1.18-7.72), the number of chicken breeds present (AOR: 2.4; 95% CI: 1.01-5.67), source of birds (AOR: 2.35; 95% CI: 1.0-5.53), separation of sick birds (AOR: 3.04; 95% CI: 1.34-6.92), disposal of waste/dead birds (AOR: 3.16; 95% CI: 1.41-7.05), cleaning agent (AOR: 5.99; 95% CI: 2.26-15.82), access of dogs (AOR: 2.52; 95% CI: 1.12-5.7), wild birds observed on site (AOR: 2.31; 95% CI: 1.01-5.3). The study further revealed a substantial prevalence of AIV with H5 and H9 subtypes in peri-urban and rural LBMs. The inadequate biosecurity measures at poultry stalls in Bangladesh increase the risk of AIV transmission from poultry to humans. To prevent the spread of AIV to humans and wild birds, we suggest implementing regular surveillance at live bird markets and enhancing biosecurity practices in peri-urban and rural areas in Bangladesh.
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Affiliation(s)
- Ariful Islam
- EcoHealth Alliance, New York, NY, United States
- Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Waurn Ponds, VIC, Australia
- *Correspondence: Ariful Islam,
| | - Shariful Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Monjurul Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mohammad Enayet Hossain
- One Health Laboratory, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sarah Munro
- EcoHealth Alliance, New York, NY, United States
| | - Mohammed Abdus Samad
- National Reference Laboratory for Avian Influenza, Bangladesh Livestock Research Institute (BLRI), Savar, Bangladesh
| | - Md. Kaisar Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Mohammad Mahmudul Hassan
- Queensland Alliance for One Health Sciences, School of Veterinary Science, University of Queensland, Brisbane, QLD, Australia
| | - Mohammed Ziaur Rahman
- One Health Laboratory, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Carson A, Stirling-Cameron E, Paynter M, Munro S, Norman WV, Kilpatrick K, Begun S, Martin-Misener R. Barriers and enablers to nurse practitioner implementation of medication abortion in Canada: A qualitative study. PLoS One 2023; 18:e0280757. [PMID: 36701296 PMCID: PMC9879445 DOI: 10.1371/journal.pone.0280757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.
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Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Murray JB, Sharp A, Munro S, Janssen PA. Expectant parents’ preferences for teaching by texting: a development and usability study of SmartMom (Preprint). JMIR Form Res 2022; 7:e44661. [PMID: 37071451 PMCID: PMC10155084 DOI: 10.2196/44661] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/28/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. OBJECTIVE We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. METHODS This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. RESULTS We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that "having reliable information is the most important thing" (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality ("It was nice to have that [information] fed to you"; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom's opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. CONCLUSIONS The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology-based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.
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Affiliation(s)
- Jennifer B Murray
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Sharp
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Patricia A Janssen
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [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: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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Zusman EZ, Munro S, Norman WV, Soon JA. Pharmacist direct dispensing of mifepristone for medication abortion in Canada: a survey of community pharmacists. BMJ Open 2022; 12:e063370. [PMID: 36207038 PMCID: PMC9557265 DOI: 10.1136/bmjopen-2022-063370] [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: 11/03/2022] Open
Abstract
INTRODUCTION Pharmacists were acknowledged as the most appropriate healthcare professional to dispense mifepristone for medication abortion shortly after the prescription therapy became available in January 2017 in Canada. OBJECTIVE We aimed to identify the facilitators and barriers for successful initiation and ongoing dispensing of mifepristone among community pharmacists across Canada. STUDY DESIGN We surveyed community pharmacists from urban/rural practice settings across Canada by recruiting from January 2017 to January 2019 through pharmacist organisations, professional networks, at mifepristone training courses and at professional conferences. The Diffusion of Innovations theory informed the study design, thematic analysis and interpretation of findings. We summarised categorical data using counts and proportions, χ2 tests, Wilcoxon rank-sum and proportional odds logistic regression. RESULTS Of the 433 responses from dispensing community pharmacists across 10/13 Canadian provinces and territories, 93.1% indicated they were willing and ready to dispense mifepristone. Key facilitators were access to a private consultation setting (91.4%), the motivation to increase accessibility for patients (87.5%) and to reduce pressure on the healthcare system (75.3%). The cost of the mifepristone/misoprostol product was an initial barrier, subsequently resolved by universal government subsidy. A few pharmacists mentioned liability, lack of prescribers or inadequate stock as barriers. CONCLUSIONS Pharmacist respondents from across Canada reported being able and willing to dispense mifepristone and rarely mentioned barriers to stocking/dispensing the medication in the community pharmacy setting. The removal of initial regulatory obstacles to directly dispense mifepristone to patients facilitated the provision of medication abortion in the primary care setting.
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Affiliation(s)
- Enav Z Zusman
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Judith A Soon
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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18
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MacLeod MLP, Leese J, Garraway L, Oelke ND, Munro S, Bailey S, Hoens AM, Loo S, Valdovinos A, Wick U, Zimmer P, Li LC. Engaging with patients in research on knowledge translation/implementation science methods: a self study. Res Involv Engagem 2022; 8:41. [PMID: 35941661 PMCID: PMC9358643 DOI: 10.1186/s40900-022-00375-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In 2017, the British Columbia (Canada) SUPPORT (SUpport for People and Patient-Oriented Research) Unit created six methods clusters to advance methodologies in patient and public oriented research (POR). The knowledge translation (KT)/implementation science methods cluster identified that although there was guidance about how to involve patients and public members in POR research generally, little was known about how best to involve patients and public members on teams specifically exploring POR KT/implementation science methodologies. The purpose of this self-study was to explore what it means to engage patients and the public in studies of POR methods through the reflections of members of five KT/implementation science teams. METHODS Informed by a collaborative action research approach, this quality improvement self-study focused on reflection within four KT/implementation science research teams in 2020-2021. The self-study included two rounds of individual interviews with 18 members across four teams. Qualitative data were analyzed using a thematic analysis approach followed by a structured discussion of preliminary findings with the research teams. Subsequently, through two small group discussion sessions, the patients/public members from the teams refined the findings. RESULTS Undertaking research on POR KT/implementation science methodologies typically requires teams to work with the uncertainty of exploratory and processual research approaches, make good matches between patients/public members and the team, work intentionally yet flexibly, and be attuned to the external context and its influences on the team. POR methodological research teams need to consider that patients/public members bring their life experiences and world views to the research project. They become researchers in their own right. Individual and team reflection allows teams to become aware of team needs, acknowledge team members' vulnerabilities, gain greater sensitivity, and enhance communication. CONCLUSIONS The iterative self-study process provided research team members with opportunities for reflection and new understanding. Working with patients/public team members as co-researchers opens up new ways of understanding important aspects of research methodologies, which may influence future KT/implementation science research approaches.
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Affiliation(s)
- Martha L. P. MacLeod
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, The Ottawa Hospital Research Institute, Ottawa, Canada
- Arthritis Research Canada, Vancouver, BC Canada
| | - Leana Garraway
- Health Research Institute, University of Northern British Columbia, Prince George, BC Canada
| | - Nelly D. Oelke
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC Canada
- Rural Coordination Centre of BC, Vancouver, BC Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
| | - Sacha Bailey
- BC Centre for Ability, Vancouver, BC Canada
- Centre for Research on Children and Families, Montreal, QC Canada
| | - Alison M. Hoens
- Arthritis Research Canada, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
| | - Sunny Loo
- Patient Partner, Michael Smith Health Research BC, PaCER Certified, University of Calgary, Calgary, AB Canada
| | - Ana Valdovinos
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC Canada
| | - Ursula Wick
- University of British Columbia, Okanagan, Kelowna, BC Canada
| | - Peter Zimmer
- University of Northern British Columbia, Prince George, BC Canada
| | - Linda C. Li
- Arthritis Research Canada, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
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19
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Dunn S, Munro S, Devane C, Guilbert E, Jeong D, Stroulia E, Soon JA, Norman WV. A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study. J Med Internet Res 2022; 24:e34302. [PMID: 35511226 PMCID: PMC9121225 DOI: 10.2196/34302] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement (CAPS-CPCA) VCoP and explore physicians’ experience with CAPS-CPCA and their views on its value in supporting implementation. Methods This was a mixed methods intrinsic case study of Canadian health care providers’ use and physicians’ perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians’ characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians’ experiences and perceptions of the VCoP. Results From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project’s knowledge translation activities with policy makers to mitigate these barriers. Conclusions A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028443
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Affiliation(s)
- Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Science, University of British Columbia, Vancouver, BC, Canada
| | - Courtney Devane
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Edith Guilbert
- Department of Obstetrics, Gynecology and Reproduction, Laval University, Quebec City, QC, Canada
| | - Dahn Jeong
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eleni Stroulia
- Department of Computer Science, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Judith A Soon
- Contraception and Abortion Research Team, Women's Health Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Munro S, Ennis M, Olure B, Kean L, Begun S, Martin L, Harris L, Renner R. Experiences of Stigma and Harassment Among Canadian Abortion Providers: Results of the National CAPS Survey. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.077] [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: 11/16/2022]
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21
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Carson A, Paynter M, Norman WV, Munro S, Roussel J, Dunn S, Bryant-Lukosius D, Begun S, Martin-Misener R. Optimizing the Nursing Role in Abortion Care: Considerations for Health Equity. Nurs Leadersh (Tor Ont) 2022; 35:54-68. [PMID: 35339200 DOI: 10.12927/cjnl.2022.26750] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Registered nurses (RNs) provide abortion care in hospitals and clinics and support abortion care through sexual health education and family planning care in sexual health clinics, schools and family practice. Nurse practitioners (NPs) improve access to abortion not only as prescribers of medication abortion but also as primary care providers of counselling, resources about pregnancy options and abortion follow-up care in their communities. There is a need to better understand the current status of and potential scope for optimizing nursing roles in abortion care across Canada. In this article, we describe the leadership of nurses in the provision of accessible, inclusive abortion services and discuss barriers to role optimization. We present key insights from a priority-setting meeting held in 2019 with NPs and RNs engaged in medication abortion practice in their communities. As scopes of practice continue to evolve, optimization of nursing roles in abortion care is an approach to enhancing equitable access to comprehensive abortion care and family planning.
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Affiliation(s)
- Andrea Carson
- Postdoctoral Fellow, School of Nursing, Dalhousie University, Halifax, NS
| | | | - Wendy V Norman
- Associate Professor and Chair, Family Planning and Public Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Sarah Munro
- Assistant Professor, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | | | - Sheila Dunn
- Research Director, Family Practice Health Centre, Women's College Hospital; Associate Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Stephanie Begun
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Ruth Martin-Misener
- Professor and Director, School of Nursing, Dalhousie University, Halifax, NS
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22
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Rebić N, Munro S, Garg R, Hazlewood G, Amiri N, Baldwin C, Ensworth S, Proulx L, De Vera MA. “The medications are the decision-makers…” Making reproductive and medication use decisions among female patients with rheumatoid arthritis: a constructivist grounded theory. Arthritis Res Ther 2022; 24:31. [PMID: 35065668 PMCID: PMC8783434 DOI: 10.1186/s13075-021-02704-7] [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: 06/15/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To examine how female patients with RA form decisions about having children, pregnancy, and medication use.
Methods
We employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model.
Results
We recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system.
Conclusion
Our framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.
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Dineley B, Munro S, Norman WV, Zevin B, Hong D, Katiraee B, Fitzsimmons B, Renner R. Contraceptive counselling in 3 Canadian bariatric surgery clinics: a multicentre qualitative study of the experiences of patients and health care providers. CMAJ Open 2022; 10:E255-E261. [PMID: 35318249 PMCID: PMC8946645 DOI: 10.9778/cmajo.20200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evidence suggests an increase in fertility and unintended pregnancy after bariatric surgery; contraceptive counselling, traditionally defined as a discussion of contraception options, is therefore an important facet of surgical planning. Our aim was to investigate patient experiences of contraceptive counselling, the attitudes of health care providers (HCPs) toward contraceptive counselling, and their perceptions of the facilitators and barriers to contraceptive counselling in bariatric surgery clinics. METHODS We conducted a qualitative study using semistructured interviews with patients and HCPs at publicly funded Canadian bariatric surgery clinics from May 2018 to February 2019. We recruited bariatric HCPs from across Canada using snowball sampling, and recruited patient participants from 3 Canadian bariatric surgery programs. Patient participants had to be at risk of pregnancy in the postoperative period, aged 18-45 years old and have completed all preoperative counselling. We included HCPs who delivered care in a publicly funded, hospital-affiliated bariatric surgery clinic in Canada. Team members analyzed transcripts thematically. RESULTS We completed 27 interviews (patient n = 16, HCP n = 11). Our analysis identified 3 separate themes: missing information in contraception counselling, making assumptions about who would benefit from counselling and strategies for improving contraception counselling. We found patients and HCPs wanted more resources on the safety and efficacy of contraceptive methods. INTERPRETATION Our study showed a need for structured contraceptive counselling in bariatric surgery clinics. Information resources that support patients and HCPs who provide counselling are needed.
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Affiliation(s)
- Brigid Dineley
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Sarah Munro
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Wendy V Norman
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Boris Zevin
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Dennis Hong
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Babak Katiraee
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Brian Fitzsimmons
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
| | - Regina Renner
- Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
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Apantaku G, Aguiar M, Kaal KJ, Munro S, Teo M, Harrison M. Understanding multidisciplinary care for people with rheumatic disease in British Columbia, Canada, through patients, nurses and physicians voices: a qualitative policy evaluation. BMC Health Serv Res 2021; 21:1148. [PMID: 34688296 PMCID: PMC8542329 DOI: 10.1186/s12913-021-07138-0] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background In 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a ‘Multidisciplinary Care Assessments’ (MCA) billing code (G31060). Objective To describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists. Methods We conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 – August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed. Results We interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed. Conclusion Our results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals’ skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07138-0.
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Affiliation(s)
- Glory Apantaku
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405-4625 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Magda Aguiar
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405-4625 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K Julia Kaal
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405-4625 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Teo
- Balfour Medical Clinic, Penticton, BC, Canada.,Penticton Regional Hospital, Penticton, BC, Canada.,Clinicial Instructor, Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405-4625 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada. .,Arthritis Research Canada, Vancouver, BC, Canada.
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Chang C, Munro S. 370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route.
Method
questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching.
Results
Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘.
Conclusions
There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.
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Affiliation(s)
- C Chang
- Department of Plastic Surgery, Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, United Kingdom
| | - S Munro
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Wahl K, Ennis M, Jeong D, Knight K, Renner R, Munro S, Dunn S, Guilbert E, Norman WV. POSTER ABSTRACTS. Contraception 2021. [PMCID: PMC8421027 DOI: 10.1016/j.contraception.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Chan MC, Munro S, Schummers L, Albert A, Mackenzie F, Soon JA, Ragsdale P, Fitzsimmons B, Renner R. Dispensing and practice use patterns, facilitators and barriers for uptake of ulipristal acetate emergency contraception in British Columbia: a mixed-methods study. CMAJ Open 2021; 9:E1097-E1104. [PMID: 34848550 PMCID: PMC8648349 DOI: 10.9778/cmajo.20200193] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ulipristal acetate 30 mg became available as prescription-only emergency contraception in British Columbia, Canada, in September 2015, as an addition to over-the-counter levonorgestrel emergency contraception. In this study, we determined dispensing and practice use patterns for ulipristal acetate, as well as facilitators of and barriers to emergency contraception for physicians, pharmacists and patients in BC. METHODS In the quantitative component of this mixed-methods study, we examined ulipristal acetate use from September 2015 to December 2018 using a database that captures all outpatient prescription dispensations in BC (PharmaNet) and another capturing market sales numbers for all oral emergency contraception in BC (IQVIA). We analyzed the quantitative data descriptively. We conducted semistructured interviews from August to November 2019, exploring barriers and facilitators affecting the use of ulipristal acetate. We performed iterative qualitative data collection and thematic analysis guided by Michie's Theoretical Domains Framework. RESULTS Over the 3-year study period, 318 patients filled 368 prescriptions for ulipristal acetate. Use of this agent increased between 2015 and 2018. However, levonorgestrel use by sales (range 118 897-129 478 units/yr) was substantially higher than use of ulipristal acetate (range 128-389 units/yr). In the 39 interviews we conducted, from the perspectives of 12 patients, 12 community pharmacists, and 15 prescribers, we identified the following themes and respective theoretical domains as barriers to access: low awareness of ulipristal acetate (knowledge), beliefs and experiences related to shame and stigma (beliefs about consequences), and multiple health system barriers (reinforcement). INTERPRETATION Use of ulipristal acetate in BC was low compared with use of levonorgestrel emergency contraception; lack of knowledge, beliefs about consequences and health system barriers may be important impediments to expanding use of ulipristal acetate. These findings illuminate potential factors to explain low use of this agent and point to the need for additional strategies to support implementation.
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Affiliation(s)
- Michelle C Chan
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Sarah Munro
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Laura Schummers
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Arianne Albert
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Frannie Mackenzie
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Judith A Soon
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Parkash Ragsdale
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Brian Fitzsimmons
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Regina Renner
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
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Aguiar M, Laba TL, Munro S, Burch T, Beckett J, Kaal KJ, Bansback N, Hudson M, Harrison M. Co-production of randomized clinical trials with patients: a case study in autologous hematopoietic stem cell transplant for patients with scleroderma. Trials 2021; 22:611. [PMID: 34503552 PMCID: PMC8428135 DOI: 10.1186/s13063-021-05575-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/27/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Increasingly, it is argued that clinical trials struggle to recruit participants because they do not respond to key questions or study treatments that patients will be willing or able to use. This study explores how elicitation of patient-preferences can help designers of randomized controlled trials (RCTs) understand the impact of changing modifiable aspects of treatments or trial design on recruitment. METHODS Focus groups and a discrete choice experiment (DCE) survey were used to elicit preferences of people with scleroderma for autologous hematopoietic stem cell transplant (AHSCT) treatment interventions. Preferences for seven attributes of treatment (effectiveness, immediate and long-term risk, care team composition and experience, cost, travel distance) were estimated using a mixed-logit model and used to predict participation in RCTs. RESULTS Two hundred seventy-eight people with scleroderma answered the survey. All AHSCT treatment attributes significantly influenced preferences. Treatment effectiveness and risk of late complications contributed the most to participants' choices, but modifiable factors of distance to treatment center and cost also affected preferences. Predicted recruitment rates calibrated with participation in a recent trial (33%) and suggest offering a treatment closer to home, at lower patient cost, and with holistic, multidisciplinary care could increase participation to 51%. CONCLUSIONS Through a patient engaged approach to preference elicitation for different features of AHSCT treatment options, we were able to predict what drives the decisions of people with scleroderma to participate in RCTs. Knowledge regarding concerns and the trade-offs people are willing to make can inform clinical study design, improving recruitment rates and potential uptake of the treatment of interest.
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Affiliation(s)
- Magda Aguiar
- Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University Technology Sydney, Sydney, NSW, Australia
| | - Sarah Munro
- Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Tiasha Burch
- Scleroderma Association of BC, Vancouver, BC, Canada
- Patient Partner, Vancouver, Canada
| | | | - K Julia Kaal
- Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Marie Hudson
- Arthritis Research Canada, Richmond, BC, Canada
- Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada.
- Arthritis Research Canada, Richmond, BC, Canada.
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Ennis M, Wahl K, Jeong D, Knight K, Renner R, Munro S, Dunn S, Guilbert E, Norman WV. The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic. Fam Pract 2021; 38:i30-i36. [PMID: 34448482 PMCID: PMC8414916 DOI: 10.1093/fampra/cmab083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. OBJECTIVE We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. METHODS We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. RESULTS Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. CONCLUSIONS Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. PODCAST An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.
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Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Dahn Jeong
- The School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kira Knight
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology, Laval University, Quebec City, QC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Munro S, Wahl K, Soon JA, Guilbert E, Wilcox ES, Leduc-Robert G, Ansari N, Devane C, Norman WV. Pharmacist dispensing of the abortion pill in Canada: Diffusion of Innovation meets integrated knowledge translation. Implement Sci 2021; 16:76. [PMID: 34344393 PMCID: PMC8330203 DOI: 10.1186/s13012-021-01144-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since Canadian drug regulatory approval of mifepristone for medical abortion in 2015 and its market availability in January 2017, the role of pharmacists in abortion provision has changed rapidly. We sought to identify the factors that influenced the initiation and provision of medical abortion from the perspectives of Canadian pharmacists, bridging two frameworks - Diffusion of Innovation in Health Service Organizations and integrated knowledge translation. METHODS We conducted one-on-one semi-structured interviews with pharmacists residing in Canada who intended to stock and dispense mifepristone within the first year of availability. Our data collection, analysis, and interpretation were guided by reflexive thematic analysis and supported by an integrated knowledge translation partnership with pharmacy stakeholders. RESULTS We completed interviews with 24 participants from across Canada: 33% had stocked and 21% had dispensed mifepristone. We found that pharmacists were willing and able to integrate medical abortion care into their practice and that those who had initiated practice were satisfied with their dispensing experience. Our analysis indicated that several key Diffusion of Innovation constructs impacted the uptake of mifepristone, including: innovation (relative advantage, complexity and compatibility, technical support), system readiness (innovation-system fit, dedicated time, resources), diffusion and dissemination (expert opinion, boundary spanners, champions, social networks, peer opinions), implementation (external collaboration), and linkage. Participants' experiences suggest that integrated knowledge translation facilitated evidence-based changes to mifepristone dispensing restrictions, and communication of those changes to front line pharmacists. CONCLUSIONS We illustrate how Diffusion of Innovation and integrated knowledge translation may work together as complimentary frameworks for implementation science research. Unlike in the USA, UK, and other highly regulated settings globally, pharmacists in Canada are permitted to dispense mifepristone for medical abortion. We contribute to literature that shows that mifepristone dispensed outside of hospitals, clinics, and medical offices is safe and acceptable to both patients and prescribers. This finding is of particular importance to the current COVID-19 pandemic response and calls for continued and equitable access to abortion care in primary practice.
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Affiliation(s)
- Sarah Munro
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada. .,Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kate Wahl
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edith Guilbert
- Department of Obstetrics, Gynaecology and Reproduction, Laval University, Quebec City, Quebec, Canada
| | - Elizabeth S Wilcox
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Genevieve Leduc-Robert
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadra Ansari
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Courtney Devane
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Starr TK, Talukdar S, Chang Z, Cepela J, Tastad C, Shetty M, Schneider I, Woo J, Macchietto M, Henzler C, Zhang Y, Baller J, Aiferis C, Munro S, Nelson AC, Wang J, Winterhoff BJ. Abstract 1410: Chemotherapy resistance pathways identified in ovarian cancer patients treated with neoadjuvant chemotherapy using single cell RNA sequencing of matched tumor biopsies. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Women with ovarian cancer suffer from a high rate of mortality due to the development of chemotherapy resistance. To better understand the mechanisms of chemotherapy resistance we initiated a prospective study of women with ovarian cancer, which we refer to as the Ovarian Cancer Precision Medicine Initiative (OCPMI) where we collect tumor biopsies and perform comprehensive molecular analyses. Our goal is to use the molecular data from these specimens to understand the mechanisms of chemo-resistance and use that information to improve therapeutic approaches.
Methods: In this study, we report our analysis of pairs of matched tumor specimens taken from seven ovarian cancer patients enrolled in OCPMI who were treated using neoadjuvant chemotherapy (NACT). The first tumor specimen was taken at time of initial diagnostic biopsy (pre-NACT), while the matched second tumor biopsy was taken after NACT administration (post-NACT), during interval debulking surgery. All fourteen tumor biopsies were subjected to single cell RNA sequencing to generate gene expression data on 54,827 pre-NACT cells and 30,661 post-NACT cells. Bioinformatic techniques were used to compare the post-NACT tumor cells that had experienced chemotherapy to the chemo-naïve pre-NACT tumor cells. Gene/pathway enrichment tests were performed to identify genes and pathways that correlated with the chemo resistance phenotype.
Results: In all matched biopsies we found that the majority of cells in the chemo-experienced post-NACT samples could be mapped to a subset of the cells in the chemo-naïve, pre-NACT samples based on gene expression patterns. We hypothesize that this subset of pre-NACT cells are the precursor cells that are able to withstand chemotherapy and could be the cause of recurrence. Analysis of the genes and signaling pathways that were upregulated in the chemo-resistant subset of pre-NACT cells identified potential novel therapeutic targets including TNFa signaling, JAK-STAT signaling, interferon signaling, TGFb signaling, and STK33 kinase activation.
Conclusions: Single cell RNA sequencing combined with sequential biopsies provides an unprecedented ability to understand mechanisms of response to chemotherapy. This type of analysis can be used to identify novel therapeutic approaches targeting the chemo-resistance phenotype.
Citation Format: Timothy K. Starr, Shobhana Talukdar, Zenas Chang, Jason Cepela, Christopher Tastad, Mihir Shetty, Isaac Schneider, Jun Woo, Marissa Macchietto, Christine Henzler, Ying Zhang, Joshua Baller, Constantin Aiferis, Sarah Munro, Andrew C. Nelson, Jinhua Wang, Boris J. Winterhoff. Chemotherapy resistance pathways identified in ovarian cancer patients treated with neoadjuvant chemotherapy using single cell RNA sequencing of matched tumor biopsies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1410.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Woo
- University of Minnesota, Minneapolis, MN
| | | | | | - Ying Zhang
- University of Minnesota, Minneapolis, MN
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Munro S, Benipal S, Williams A, Wahl K, Trenaman L, Begun S. Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review. PLoS One 2021; 16:e0252434. [PMID: 34197477 PMCID: PMC8248724 DOI: 10.1371/journal.pone.0252434] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- * E-mail:
| | - Savvy Benipal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aleyah Williams
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Kate Wahl
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver BC, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Rebic N, Munro S, Norman WV, Soon JA. Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing. Can Pharm J (Ott) 2021; 154:166-174. [PMID: 34104270 PMCID: PMC8165881 DOI: 10.1177/17151635211005503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nevena Rebic
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
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Munro S, Wilcox ES, Lambert LK, Norena M, Kaufman S, Encinger J, Kendall T, Thompson R. A survey of health care practitioners' attitudes toward shared decision-making for choice of next birth after cesarean. Birth 2021; 48:194-208. [PMID: 33538001 DOI: 10.1111/birt.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a history of cesarean may benefit from shared decision-making (SDM) interventions, such as patient decision aids, that provide individualized clinical information and help to clarify personal preferences. We sought to understand the factors that influence how care practitioners support choices for mode of birth and what individual and health system factors influence uptake of SDM in routine care. METHODS We conducted a cross-sectional survey of health care practitioners in British Columbia, Canada (2016-2017). Participants included family physicians, midwives, obstetricians, and registered nurses. We conducted descriptive and inferential analyses of quantitative data and subjected the open-ended survey responses to thematic analysis. RESULTS Analysis of survey responses (n = 307) suggested there was no significant association between the size of the participant hospital and their medico-legal concerns about mode of birth. Environmental factors that may influence the use of SDM included the length of time it takes to initiate an emergency cesarean and the timing of when the SDM intervention is introduced to the patient. No participants reported protocols prohibiting VBAC at their hospital. Participants preferred an SDM approach where the pregnant person is involved in making the final decision for mode of birth. CONCLUSIONS Although maternity care practitioners express attitudes and behaviors that may support SDM for mode of birth after cesarean, implementing SDM using a patient decision aid alone may be challenging because of environmental factors. Our study demonstrates how survey data can aid in identifying how, when, where, for whom, and why an SDM intervention could be implemented.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth S Wilcox
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Leah K Lambert
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Sarah Kaufman
- Clinical Nurse Specialist, Fraser Health Authority, Surrey, BC, Canada
| | - Jana Encinger
- Clinical Quality and Systems Improvement, Perinatal Services BC, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Tamil Kendall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rachel Thompson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Shaffer VA, Brodney S, Gavaruzzi T, Zisman-Ilani Y, Munro S, Smith S, Thomas E, Valentine KD, Bekker HL. Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards. Med Decis Making 2021; 41:897-906. [PMID: 34027739 DOI: 10.1177/0272989x211011100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand. METHOD To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms. RESULTS The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context. CONCLUSION Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.
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Affiliation(s)
- Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Suzanne Brodney
- Division of Internal Medicine, Massachusetts General Hospital, Padova, Veneto, Italy
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, Universita degli Studi di Padova Scuola di Psicologia, Padova, Veneto, Italy
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sian Smith
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Thomas
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | | | - Hilary L Bekker
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Wahl K, Brooks M, Chokmorova N, Desjardins-Lorimer K, Marchand C, Norman WV, Segall R, Williams A, Munro S. User-centred design and development of a patient decision aid for choice of first trimester abortion method. Journal of Obstetrics and Gynaecology Canada 2021. [DOI: 10.1016/j.jogc.2021.02.074] [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: 11/30/2022]
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Rebić N, Garg R, Ellis U, Kitchin V, Munro S, Hazlewood G, Amiri N, Bansback N, De Vera MA. "Walking into the unknown…" key challenges of pregnancy and early parenting with inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies. Arthritis Res Ther 2021; 23:123. [PMID: 33882998 PMCID: PMC8059168 DOI: 10.1186/s13075-021-02493-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background To conduct a systematic review and thematic synthesis of qualitative studies on the pregnancy and early parenting experiences of patients with inflammatory arthritis (IA). Methods We searched online databases for English-language, qualitative studies capturing the experiences of females with IA or their healthcare providers with pregnancy and/or early parenthood. We extracted findings from included studies and used thematic synthesis to develop descriptive and higher-order analytical themes. Results Of 20 included studies, our analysis identified 5 analytical themes among patients and 3 among providers. Patients’ reproductive desires, the impact of IA on their ability to experience pregnancy, and the availability of information to guide preparedness informed their pregnancy decisions. Patients’ IA management, pregnancy expectations, and access to support influenced their reproductive experiences. Patients’ experiences seeking information and care revealed substantial gaps in reproductive care provision to patients with IA. Reproductive uncertainty related to IA placed a heavy burden on patients’ emotional and psychological wellbeing. Reproductive care provision was influenced by providers’ perceived professional responsibility to address patients’ reproductive goals, fears of negative outcomes, and capacity to harness patient trust, incorporate reproductive care into rheumatology practice and facilitate multi-disciplinary care coordination. Conclusions Our review illuminated several barriers to experiencing pregnancy among patients with IA, particularly related to pregnancy planning support, availability of information, and care coordination among the patient’s healthcare team. To improve care, these barriers may be mitigated through the provision of relevant, practical, and consistent information as well as patient-centred multi-disciplinary approaches for managing pregnancy among patients with IA.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- University of British Columbia Library, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Vanessa Kitchin
- University of British Columbia Library, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC, V6Z 2K8, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada
| | - Glen Hazlewood
- Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada.,Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Neda Amiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, 802-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,School of Populations and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada. .,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Witschen PM, Chaffee TS, Brady NJ, Knutson TP, LaRue RS, Munro S, Tiegs L, McCarthy JB, Nelson AC, Schwertfeger KL. Abstract PO041: Hyaluronan processing and function in the progression of breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.tme21-po041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Hyaluronan (HA) is a large, soluble, glycosaminoglycan of the extracellular matrix that has anti-inflammatory effects under physiologic conditions. However, HA is cleaved into low molecular weight (LMW) fragments under conditions of cellular or organismal stress, acting as a molecular “switch” that promotes inflammation. In breast cancer, a decrease in HA synthesis has been correlated with decreased tumor cell proliferation and migration. However, the roles of HA fragmentation in the progression of breast cancer are unknown. We predict that HA fragmentation increases during this transition, promoting inflammation through LMW HA-CD44 interactions. To test our hypothesis, the presence/absence of HA fragmentation was determined using gel electrophoresis in breast cancer cell lines. Additionally, qRT-PCR was performed to examine gene expression of the three major hyaluronan synthases (Has) 1-3 and the three major hyaluronidases (Hyal) 1, 2, and PH-20. Our data suggest as a cancerous lesion progresses, HMW HA production increases (primarily through Has2), but HA fragmentation does not occur until the tumor acquires a more aggressive phenotype (primarily through Hyal1). Following characterization of HA fragmentation and machinery within our system, we found changes in inflammatory cytokines (such as CCL2) as downstream effects of CD44 and HA synthesis inhibition. We have currently knocked out CD44 in two breast cancer cell lines using the CRISPR/Cas9 method to determine the functional relationship between CD44 and HA using an in vivo mouse model. By targeting HA-CD44 signaling associated with inflammation, new therapeutic approaches can be developed for the treatment of breast cancer.
Citation Format: Patrice M. Witschen, Thomas S. Chaffee, Nicholas J. Brady, Todd P. Knutson, Rebecca S. LaRue, Sarah Munro, Lyubov Tiegs, James B. McCarthy, Andrew C. Nelson, Kathryn L. Schwertfeger. Hyaluronan processing and function in the progression of breast cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on the Evolving Tumor Microenvironment in Cancer Progression: Mechanisms and Emerging Therapeutic Opportunities; in association with the Tumor Microenvironment (TME) Working Group; 2021 Jan 11-12. Philadelphia (PA): AACR; Cancer Res 2021;81(5 Suppl):Abstract nr PO041.
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Starks ER, Swanson L, Docking TR, Bosdet I, Munro S, Moore RA, Karsan A. Assessing Limit of Detection in Clinical Sequencing. J Mol Diagn 2021; 23:455-466. [PMID: 33486075 DOI: 10.1016/j.jmoldx.2020.12.010] [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] [Received: 08/22/2019] [Revised: 12/05/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022] Open
Abstract
Clinical reporting of solid tumor sequencing requires reliable assessment of the accuracy and reproducibility of each assay. Somatic mutation variant allele fractions may be below 10% in many samples due to sample heterogeneity, tumor clonality, and/or sample degradation in fixatives such as formalin. The toolkits available to the clinical sequencing community for correlating assay design parameters with assay sensitivity remain limited, and large-scale empirical assessments are often relied upon due to the lack of clear theoretical grounding. To address this uncertainty, a theoretical model was developed for predicting the expected variant calling sensitivity for a given library complexity and sequencing depth. Binomial models were found to be appropriate when assay sensitivity was only limited by library complexity or sequencing depth, but functional scaling for library complexity was necessary when both library complexity and sequencing depth were co-limiting. This model was empirically validated with sequencing experiments by using a series of DNA input amounts and sequencing depths. Based on these findings, a workflow is proposed for determining the limiting factors to sensitivity in different assay designs, and the formulas for these scenarios are presented. The approach described here provides designers of clinical assays with the methods to theoretically predict assay design outcomes a priori, potentially reducing burden in clinical tumor assay design and validation efforts.
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Affiliation(s)
- Elizabeth R Starks
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada.
| | - Lucas Swanson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - T Roderick Docking
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Ian Bosdet
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Munro
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Aly Karsan
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Joseph-Williams N, Abhyankar P, Boland L, Bravo P, Brenner AT, Brodney S, Coulter A, Giguere A, Hoffman A, Körner M, Langford A, Légaré F, Matlock D, Moumjid N, Munro S, Dahl Steffensen K, Stirling C, van der Weijden T. What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration. Med Decis Making 2020; 41:907-937. [PMID: 33319621 PMCID: PMC8474331 DOI: 10.1177/0272989x20978208] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 01/25/2023]
Abstract
BACKGROUND Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting. AIM This review was conducted in response to the IPDAS Collaboration's evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. METHODS Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research. RESULTS We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve. CONCLUSIONS We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.
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Affiliation(s)
| | - Purva Abhyankar
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Laura Boland
- The Ottawa Hospital Research Institute, School of Health Sciences, Ottawa, Canada and Western University, School of Health Studies, London, ON, Canada
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, University of North Carolina Medical School, Chapel Hill, NC, USA, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne Brodney
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Aubri Hoffman
- Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs University, Freiburg, Germany
| | - Aisha Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université of Laval, Quebec, Canada
| | - Daniel Matlock
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Nora Moumjid
- Claude Bernard Lyon 1 University, Léon Bérard Cancer Centre, Lyon, Rhone-Alpes, France
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Region of Southern Denmark and Department of Clinical Oncology, Vejle/Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark and Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Trudy van der Weijden
- CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
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Munro S, Guilbert E, Wagner MS, Wilcox ES, Devane C, Dunn S, Brooks M, Soon JA, Mills M, Leduc-Robert G, Wahl K, Zannier E, Norman WV. Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study. Ann Fam Med 2020; 18:413-421. [PMID: 32928757 PMCID: PMC7489974 DOI: 10.1370/afm.2562] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. METHODS We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. RESULTS We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. CONCLUSION Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Marie-Soleil Wagner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Elizabeth S Wilcox
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Courtney Devane
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Sheila Dunn
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Judith A Soon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Megan Mills
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Genevieve Leduc-Robert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Erik Zannier
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.).
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Aguiar M, Harrison M, Munro S, Burch T, Kaal KJ, Hudson M, Bansback N, Laba TL. Designing Discrete Choice Experiments Using a Patient-Oriented Approach. Patient 2020; 14:389-397. [PMID: 32676996 DOI: 10.1007/s40271-020-00431-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient-oriented research is a process whereby patients or caregivers are included as research partners so that research focusses on topics that are priorities and lead to findings that translate into practice. Using a case study of preferences for stem cell transplant in scleroderma, we report on a patient-oriented research approach to developing a discrete choice experiment. Our patient-oriented research application followed the four guiding principles in Canada's Strategy for Patient-Oriented Research: inclusiveness, support, mutual respect and co-build. In this case study, patient partners were involved at different levels of engagement to match individual availability, skillset and roles in the team. They advised, to different degrees, on all aspects of the study from design to analyses. Using a patient-oriented research approach led to the inclusion of attributes that would likely have been excluded (e.g. support from a multidisciplinary team), and realistic framing of patient-relevant and sometimes sensitive attributes (e.g. mortality and cost). Meeting locations and times were adjusted to accommodate all-team circumstances. Institutional constraints on the reimbursement for patient partners influenced the timing and extent of involvement. We found that adopting a patient-oriented research approach to discrete choice experiment design injected unique knowledge and expertise into the team, improved the representativeness of the sample recruited, minimised researcher biases, and ensured appropriate attribute selection and descriptions. The patient-oriented research approach highlighted some constraints of discrete choice experiment designs and, while not a solution, might ensure the methodological trade-offs remain patient relevant. Institutional challenges must be addressed to progress patient-oriented health economics research.
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Affiliation(s)
- Magda Aguiar
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | - Sarah Munro
- Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tiasha Burch
- Scleroderma Association of British Columbia, North Vancouver, BC, Canada
| | - K Julia Kaal
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marie Hudson
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Nick Bansback
- Centre for Healthcare Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University Technology Sydney, Sydney, NSW, Australia
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Norman WV, Munro S. Let's keep our eye on the ball. BMJ Sex Reprod Health 2020; 46:159-160. [PMID: 32665230 PMCID: PMC7392478 DOI: 10.1136/bmjsrh-2020-200703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Wendy V Norman
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Chan M, Soon J, Schummers L, Munro S, Ragsdale P, Albert A, Fitzsimmons B, Renner R. Current dispensing and practice use patterns of ulipristal acetate 30mg (Ella®), as emergency contraception in British Columbia, Canada. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.030] [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: 11/16/2022]
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Norman W, Munro S, Sou J, Bansback N. What are health care professionals’ decision-making needs when supporting infant feeding choices? Results of a qualitative investigation. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.085] [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: 11/25/2022]
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46
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Gong M, Munro S, Koenig N, Geoffrion R. The pelvic floor and pregnancy. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Gong M, Munro S, Koenig N, Geoffrion R. Pregnancy, childbirth and the pelvic floor. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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Guilbert E, Wagner MS, Munro S, Wilcox E, Dunn S, Devane C, Soon J, Norman W. Explaining slow implementation of mifepristone in Quebec with the transtheoretical model of change. Journal of Obstetrics and Gynaecology Canada 2020. [DOI: 10.1016/j.jogc.2020.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guilbert E, Wagner MS, Munro S, Wilcox ES, Dunn S, Soon JA, Devane C, Norman WV. Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation. EUR J CONTRACEP REPR 2020; 25:190-198. [PMID: 32312130 DOI: 10.1080/13625187.2020.1743825] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Mifepristone for first-trimester medical termination of pregnancy (MTOP) became available in Quebec in 2018, one year after the rest of Canada. Using the theory of the Diffusion of Innovation (DOI) and the transtheoretical model of change (TTM), we investigated factors influencing the implementation of mifepristone MTOP in Quebec.Material and Methods: Semi-structured interviews were conducted with 37 Quebec physicians in early 2018. Deductive thematic analysis guided by the theory of DOI explored facilitators and barriers to physicians' adoption of mifepristone MTOP. We then classified participants into five stages of mifepristone adoption based on the TTM. Follow-up data collection one year later assessed further adoption.Results: At baseline, three physicians provided mifepristone MTOP (Maintenance) and two were about to start (Action). Thirteen physicians at Preparation and Advanced Contemplation stages intended to start while, within the Slow Contemplation, two intended to start and ten were unsure. Seven had no intention to provide mifepristone MTOP (Pre-Contemplation). Major reported barriers were: complexity of local health care organisations, medical policy restrictions, lack of support, and general uncertainty. One year later, ten physicians provided mifepristone MTOP (including three at baseline) and nine still intended to, while seventeen did not intend to start provision. Seven of sixteen participants (44%) who worked in TOP clinics at baseline were still not providing MTOP with mifepristone one year later.Conclusion: Despite ideological support, mifepristone MTOP uptake in Quebec is slow and laborious, mainly due to restrictive medical policies, vested interests in surgical provision and administrative inertia.
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Affiliation(s)
- Edith Guilbert
- Department of Obstetrics, Gynecology and Reproduction, Laval University, CHU de Québec, Quebec, Canada
| | - Marie-Soleil Wagner
- Department of Obstetrics and Gynecology, University of Montreal, CHU Sainte-Justine, Montreal, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Elizabeth S Wilcox
- Centre for Health Evaluation and Outcome Sciences, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, Women's College Research Institute, Toronto, Canada
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Courtney Devane
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Moore RA, Zeng T, Docking TR, Bosdet I, Butterfield YS, Munro S, Li I, Swanson L, Starks ER, Tse K, Mungall AJ, Holt RA, Karsan A. Sample Tracking Using Unique Sequence Controls. J Mol Diagn 2020; 22:141-146. [DOI: 10.1016/j.jmoldx.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/27/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023] Open
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