A69 ASSESSING COVID-19 VACCINATION COMPLIANCE AND HESITANCY IN THE EARLY ADULT (18-25YRS) INFLAMMATORY BOWEL DISEASE (IBD) POPULATION

Background

Effective strategies at educating high risk IBD patients about COVID-19 and the benefits of vaccination is critical.

Purpose

The primary objective of this study was to assess the impact of early adulthood (18-25 years) on COVID-19 vaccination compliance. Secondary objectives were to assess the impact of early adulthood on vaccine hesitancy and reasons for non-compliance.

Method

A retrospective chart review was performed on all eligible IBD patients. Inclusion criteria: patients followed at Women’s College Hospital, age 18 years and older, diagnosis of Crohn’s disease (CD), Ulcerative Colitis (UC) or Indeterminant Colitis (IC). Data was collected between January 01 and August 31, 2022. Demographic data, level of immunosuppression and COVID-19 vaccine status were collected. All participants identified as not fully vaccinated (defined as less than 3 COVID-19 vaccines) were enrolled into the second phase of the study in which a modified Oxford COVID-19 Vaccine Hesitancy Scale was administered, and reasons for vaccine hesitancy discussed and addressed using a prepared educational template. Chi-square test evaluated the impact of age on vaccination status. Adjusted logistic regression was also performed. Fisher exact test evaluated the impact of age on willingness to accept vaccination counseling. Generalized linear regression model evaluated the impact of this on vaccine hesitancy.

Result(s)

287 patients were included in the study of which 254 (89%) were immunosuppressed, 197 (69%) were female. 144 (50%) had CD, 136 (47%) had UC and 7 (2.4%) had IC. There were significantly more young adults who were under/unvaccinated 22/82 (27%) compared to older adults 22/205 (11%), p=0.0006 . Gender, IBD phenotype, immunosuppression status did not significantly affect vaccination status. The only variable found to significantly affect vaccination status on adjusted logistic regression was age, >25 years associated with OR 3.25 (95% CI 1.63-6.50) for full vaccination. 32/39 study subjects who were un/under-vaccinated agreed to counseling (82% of the early adults and 82% of older adults). Gender, IBD phenotype, immunesuppression status and age had no impact on uptake. Linear regression modeling found no significant impact on vaccine hesitancy by age, gender, IBD phenotype or immunesuppression. The main reasons described by patients for hesitancy included safety concerns and potential side effects (43%), perceived low risk (27%), prior COVID-19 infection (17%), lack of knowledge of current public health guidance (13%).

Conclusion(s)

Early adult IBD patients were found to be significantly less compliant with obtaining COVID-19 vaccines. This hesitancy mainly stems from concerns regarding vaccine safety and efficacy and perceived low risk. More targeted education strategies are required to increase awareness and ensure vaccine compliance.

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Disclosure of Interest

None Declared

A89 EXPLORING THE ENDOSCOPY SEDATION EXPERIENCES OF INDIVIDUALS WITH PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE (IBD) AFTER THE TRANSITION TO ADULT CARE: A PILOT STUDY

Background

Different sedation practices are utilized in pediatric and adult endoscopy settings. While pediatric endoscopies are performed under deep sedation, adult endoscopies are often performed under conscious sedation.

Purpose

This study sought to explore the experiences of patients with pediatric-onset IBD that have undergone transfer to adult care and to identify gaps in endoscopy sedation practices that may inform a larger and more comprehensive evaluation of this topic.

Method

A pilot study was performed at Women's College Hospital involving patients aged 18 to 25 years old with a diagnosis of pediatric-onset IBD that received endoscopies in both the pediatric and adult setting. Patients were recruited between June 1 and October 1, 2022. A 36-item questionnaire was distributed assessing sedation methods used in pediatric and adult settings, anxiety, pain, satisfaction during endoscopy and perceptions of transition of care preparation as it pertained to endoscopy. This study was reviewed by institutional authorities at WCH and was deemed not to require REB approval.

Result(s)

Twelve patients participated in the pilot survey study (7 Ulcerative colitis, 5 Crohn’s disease) with a mean age of 22. Of those, 100% were female and 66% did not have any comorbid conditions. The mean age of diagnosis was 12.8 years, with respondents spending an average of 67.3 months in pediatric care prior to transition. In pediatric care, the mean number of endoscopies received was 2.3 with a majority performed under deep sedation (83%). Respondents reported being very satisfied with their sedation experience (58%) and experiencing no pain (67%), however mild to severe anxiety was reported (58%). In adult care, mean endoscopies received was 2.1, with conscious sedation (50%) performed more often than deep (42%) or no sedation (8%). More respondents reported satisfaction with deep sedation (100%) than conscious sedation (67%). During conscious sedation, respondents experienced more pain (50% vs. 20%), moderate discomfort (33% vs. 0%), and were more anxious (83% vs. 60%) than in deep sedation. Factors that contributed to anxiety included fear of endoscopy and insufficient sedation. Of those who received deep sedation in the adult setting, 60% reported that the sedation method utilized impacted their future willingness for endoscopy. Lack of communication regarding sedation method, poor experiences with conscious sedation, and the desire to choose the sedation method appropriate for them were areas for improvement.

Conclusion(s)

This pilot study demonstrated that IBD patients transferred to adult care receive varying endoscopy sedation methods and experience differential levels of satisfaction favouring deep sedation. This is an important signal that requires larger study.

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Disclosure of Interest

None Declared

A96 GENDER DIFFERENCES IN GASTROENTEROLOGY AND HEPATOLOGY AUTHORSHIP AND EDITORIAL BOARDS

Background

Women are numerically under-represented in the field of gastroenterology and hepatology.

Aims

To characterize the gender distribution of first and senior authors and editorial board members of the highest impact factor journals in gastroenterology and hepatology.

Methods

Using Clarivate Journal Citation Report 2019, the 28 highest ranked journals within gastroenterology and hepatology were selected for review, along with the Journal of the Canadian Association of Gastroenterology. Publications between January 1 to December 31, 2019 were included. Gender of board members and authors was identified using publicly available data. Spearman correlation coefficients were calculated using SPSS to assess for a relationship between editorial board, first author, and senior author gender as well as impact factor.

Results

Of 29 journals assessed with a median impact factor of 5.55 (IQR 3.72–9.10), 357 journal issues and 8036 articles were reviewed. Three journals were headed by female chief editors, constituting 7.7% of all editors-in-chief (3/39). In total, females made up 17.1% of editorial board members (n=584). Of 8036 first authors, 2547 (31.7%) were female. Of 7335 senior authors, 1390 (19.3%) were female. There were no statistically significant correlations between impact factor and gender. Chief editor gender did not significantly correlate with gender distribution of editorial boards, first or senior authors. There was a significant positive correlation between male-dominated editorial boards and male first and senior authorship, versus a significant negative correlation between male-dominated editorial boards and female first and senior authorship. A positive correlation exists for the same gender between first and senior authors.

Conclusions

Although gender distribution of female first and senior authorship approaches current distributions in the field of gastroenterology and hepatology, editor-in-chief positions and editorial board membership on journals continue to be occupied by men in higher proportions. Future endeavors such as diversity statements and mentorship may help to balance these distributions in the future.

Funding Agencies

None

A81 BARRIERS AND FACILITATORS OF PEDIATRIC TO ADULT TRANSITION IN IBD: A PILOT STUDY EVALUATING THE STAKEHOLDER EXPERIENCE

Background

Inflammatory bowel disease (IBD) is increasing in prevalence with up to 25% of IBD patients diagnosed before 18 years of age. These patients will require graduation from pediatric care to adult services. The transition of care from pediatric to adult gastroenterologists (GIs) is a purposeful transition that requires planning with involvement of all stakeholders to ensure proper transition and avoid interruption in care.

Aims

To identify the transition experiences of adult patients with pediatric diagnoses of IBD, their parents, pediatric and adult GIs and registered nurses (RNs) and identify barriers and facilitators to a successful transition.

Methods

Patients aged 18–25 diagnosed with pediatric-onset IBD were included. Semi-structured focus groups were held with 9 patients and separately with 4 parents. Questions focused on the patient transition experience, opportunities for improvement, and patient quality of life. Transition practices and expectations of 12 adult GIs, 7 pediatric GIs and 9 IBD nurses were also investigated in a series of provider specific focus groups. The groups were audio-recorded, transcribed and qualitative themes were noted.

Results

Patients: Facilitators included ease of access to adult providers outside of clinic time and parental presence in the early stages of transition. Barriers included abrupt transitions to adult care by age 18, lack of choice regarding adult GI and lack of adult nursing.

Parents: Facilitators included an extended transition period, availability of support groups/resources. Barriers related to exclusion from the transition process and lack of input on adult GI choice.

RNs: Facilitators include having champion IBD nurses on the pediatric and adult side during transition. Barriers included lack of educational tools for patients.

Pediatric GIs: Facilitators included effective communication between adult and pediatric GIs, having an emergency assessment protocol, involving families in the transition process and access to multidisciplinary resources. Barriers included prolonged wait time for transfer and lack of adult access to multidisciplinary support.

Adult GIs: Facilitators included succinct transfer summaries and formal transition programs for high risk patients. Barriers included a lack of multidisciplinary support, difficulty reaching rural areas, heavy case loads and prolonged wait time to transfer of care.

Conclusions

This study explores the stakeholder experience of pediatric to adult transition in IBD. Themes noted related to efficient communication between GIs, streamlining transfer summaries, ensuring a gradual transition process, involving parents and ensuring access to multidisciplinary resources. Identifying barriers and facilitators during the transition process can provide insight into creating a successful pediatric to adult transitions program in IBD.

Funding Agencies

None

A94 BARRIERS TO ADVANCEMENT ALONG THE GASTROENTEROLOGY CAREER PATHWAY: A RESIDENT PERSPECTIVE

Background

GI residency training programs in Canada are comprised of approximately 30% females. Survey data from procedural specialities reveal gender related differences relating to work-life balance, parental obligations, access to role models, and workplace gender discrimination.

Aims

To determine gender specific differences affecting the choice of GI as a sub-specialty and the experience of GI as a career during residency and fellowship.

Methods

A 91-question mixed methods survey was electronically disseminated in two recruitment waves to PGY4-6 gastroenterology residents and fellows across Canada between May 7th-July 1st, 2020. The survey consisted of nine groups of questions aimed at understanding personal, professional, financial, and training characteristics. Comparisons were made between self-identified male and female genders. Wilcoxon (Mann Whitney U test) was used for continuous variables while chi-squared test and fisher’s exact test was applied for categorical variables using SAS software. Qualitative thematic analysis was applied for short answer responses with two independent reviewers.

Results

A total of 122 residents were surveyed with a response rate of 36% (44/122).There were 17 PGY4s, 15 PGY5s, and 12 PGY6s. Females comprised 41% (18/44) of respondents. Women were statistically more likely to take on a predominant caregiver role for children (p=0.012) and state that having children would slow their career advancement (p=0.046). Men were more likely to state that it is preferable to have children during residency (p=0.036) and that their partner’s preference factored into their subspecialty training choice (p=0.009) than women. Male PGY4/5 trainees were more likely to select therapeutic endoscopy for advanced training (p=0.033). No statistical difference was found regarding aspirations for administrative/leadership positions, desired future income, practice setting, academic pursuits, and perspectives on compromising marriage for career. Qualitative analysis suggests non-gender specific challenges related to achieving work-life balance, securing a desired location of practice, and obtaining financial stability are common resident and fellow concerns.

Conclusions

Our study is the first of its kind within the field of gastroenterology to focus on GI residents and fellows’ experiences within Canadian training programs. Our results show that there exist gender related differences in relation to work-life balance and career advancement. Women may benefit from supports to cope with increased caregiver demands in order to allow them to meet career goals which are similar to their male peers.

Funding Agencies

None