Knowledge, Attitudes, and Practices of COVID-19 Vaccination among Adults in Singapore: A Cross-Sectional Study

Public health measures promoting compliance of COVID-19 vaccination requires understanding of knowledge, attitudes, and practices (KAP). This study explored the KAP and risk factors influencing COVID-19 vaccination, including changes in preventive practices before and after vaccination in a high-income country, Singapore. An online cross-sectional study among Singaporeans and permanent residents aged 21 years and older was conducted from July to August 2021. Univariate and multivariable logistic regressions using RStudio version 1.4.1106 was performed to assess associations between demographic factors, KAP, and vaccination status. P values < 0.05 were considered statistically significant. A total of 869 respondents completed the survey. Individuals with higher knowledge (adjusted odds ratio [aOR] = 2.00, P = 0.024), perceived efficacy (aOR = 1.19, P = 0.004), perceived safety (aOR = 1.20, P = 0.005), and willingness to uptake (aOR = 1.55, P < 0.001) scores were more likely to be vaccinated. There was a significant increase in the use of proper handwashing techniques among the vaccinated group before and after vaccinations. The governmental risk communication approaches have been useful in instilling high levels of vaccine knowledge. High levels of good attitudes about and knowledge of COVID-19 vaccination were associated with a high level of vaccination practices. Good perceived vaccine efficacy and confidence in government were also associated with positive vaccine uptake. This study paves the way for more targeted government measures to be implemented to improve vaccination rates of COVID-19 booster vaccines in a high-income country like Singapore.

Validation of the Cancer and Aging Research Group (CARG) model to identify risks of chemotherapy toxicities in Asian older adults

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Background: Older adults are at an increased risk of chemotherapy related toxicities. Identification of risk factors can facilitate oncologists in tailoring treatment, potentially mitigate the risk of chemotherapy toxicity and improve social economic outcomes. Tools like the Karnofsky Performance Status (KPS) and Geriatric Assessment (GA) are used in clinical practice to guide treatment decisions for older adults with cancer. The CARG model incorporating the GA and clinical variables was developed and validated to predict for grade 3-5 toxicities, although this has not yet been validated in Asians. Methods: Patients ≥70 years old with solid malignancies receiving chemotherapy at the National University Cancer Institute, Singapore were recruited between June 2017 and January 2018. The study aims to verify the application of the CARG model, KPS, GA and oncologists’ estimate of toxicity in a multi-ethnic Asian population. The risks of chemotherapy toxicity were calculated using the CARG model (low risk: 0-5, medium risk: 6-9, high risk: ≥10). A GA including a physician rated KPS score (low risk: 90-100, medium risk:80, high risk: ≤70) and a timed up and go (TUG) test (low risk: ≤12s, high risk: > 12s) were performed for all patients. The attending oncologist (blinded to the CARG score) was asked to give an estimated likelihood (low/medium/high) of chemotoxicity. Chemotherapy related toxicities were captured by chart review based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The area under the receiver operating characteristic (ROC) curve and a univariate analysis of predictors of toxicity were calculated. Results: A total of 200 patients were included. Median age was 74 (range: 70-89). The ethnic makeup of the population consisted of Chinese (N = 177; 88.5%), Malay (N = 17; 8.5%), Indians (N = 4; 2%) and other ethnicities. Majority of patients were males (N = 110; 55%), had metastatic disease at diagnosis (N = 114; 57%) and had gastrointestinal cancers (N = 80; 40%). 75% (N = 150) had polychemotherapy and 55% (N = 110) received full dose chemotherapy. More than half of patients (68.5%) experienced G3-5 toxicities, with 65.5% requiring hospitalization. The CARG model predicted 22.5% of patients as low, 50.5% as medium and 27% as high risk of chemotoxicity. The area under ROC for the CARG model was 0.74 (95% CI, 0.67-0.82). A one-point increase in the CARG score was associated with a 15% increase in the odds of G3-5 toxicities. 84.5% of patients needed > 12s for the TUG test. The TUG score, KPS and oncologist’s prediction of toxicity was predictive of an increased risk of G3-5 toxicities (p < 0.01). Conclusions: This study confirms the validity of the CARG predictive model in Asians and can streamline healthcare delivery in older adults. Development of a more robust predictive model incorporating the KPS and TUG into the CARG model could be considered.

Preoperative concerns of patients undergoing general surgery

OBJECTIVES

This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period.

METHODS

Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden's methodology.

RESULTS

27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients' trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs' credibility and capabilities.

CONCLUSION

Patients' preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered.

PRACTICE IMPLICATIONS

Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.

131 Concerns of The Unheard: A Qualitative Systematic Review on The Preoperative Concerns of General Surgery Patients

Aim

Method

CINAHL, Medline, PsycINFO, and Web of Science were searched, and articles related to patients’ preoperative concerns were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden’s methodology.

Results

Three themes were generated from the 27 included articles; lead-up to surgery, the postoperative recovery process, and HCP care provision. Patients were uncertain and concerned about the impact the surgery or disease may have on them while they waited for their surgery to occur. Additionally, perceived inadequate provision of care by patients led to them doubting their HCPs’ ability, heightening their preoperative anxiety. Lastly, postoperative recovery processes were often unclear, leading to increased distress as patients wonder if they could recover from the disease and/or surgery.

Conclusions

Unresolved preoperative concerns increase patients’ anxiety and uncertainty, negatively affecting their postoperative recovery. A combination of individualized preoperative education and complementary therapy can be implemented by HCPs to alleviate these concerns, leading to better postoperative outcomes.