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The article discusses a 2024 study of the enhanced recovery after surgery (ERAS) approach to improve patients' surgical pathways via multimodal interventions. Topics covered include nurse managers' contribution to ERAS implementation, and results which show the themes of resource, innovation and change management, interprofessional collaboration, developing professional practice, and proximity team management. Also noted are the challenges of unclear roles and practice scope among stakeholders.

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Background: A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. Aims/Objectives: The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. Materials and Methods: Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. Results: Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. Conclusions and Significance: The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry. [ABSTRACT FROM AUTHOR]

Objective: Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient–physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada. Methods: We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada. Results: Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49‐4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross‐sectional design. Conclusion: Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self‐directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical. [ABSTRACT FROM AUTHOR]

The experiences of African, Caribbean and Black (ACB) Canadians are seldom explored in the Canadian context. Family physicians act as a gateway to the rest of the healthcare system and are necessary to provide proper patient care. However, Canada's history with colonialism may impact the socio-cultural context in which patients receive care. 41 participants from Waterloo Region, Ontario, were engaged in eight focus groups to discuss their experiences in the healthcare system. Data were analysed following thematic analysis. Style of care, racism and discrimination and a lack of cultural competence hindered access. oor Inadequate cultural competence was attributed to western and biomedical approaches, poor understanding of patients' context, physicians failing to address specific health concerns, and racism and discrimination. Participants highlighted that the two facilitators to care were having an ACB family physician and fostering positive relationships with physicians. Participants predominantly expressed dissatisfaction in physicians' approaches to care, which were compounded by experiences of racism and discrimination. Findings demonstrate how ACB patients are marginalized and excluded from the healthcare syste Iimplications for better access to care included utilizing community healthcare centres, increasing physicians' capacity around culturally inclusive care, and increasing access to ACB physicians. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly changed the lives of a majority of the world's population. People have been encouraged to implement social distancing behaviors enforced by governments, and have experienced loss of employment or changes to their usual working environment. In the mental health sector, psychologists and psychiatrists have been forced to alter the standard care of patients without compromising safety. This article documents the experiences of the authors – mental health professionals in four countries, Canada, Russia, Australia and Japan – at the time of the COVID-19 pandemic, and offers recommendations on how clinical, training, and research practices may need to be adjusted to deal with lockdown situations. Clinicians adapted their usual best practices by learning new skills and updating their knowledge base. Mental health clinicians noticed that the pandemic led to symptomatic changes in some of their patients. Most clinicians moved towards providing telemental health services, such as conducting assessments and treatments remotely. Those who continued seeing patients in person employed personal protective equipment with various impacts on the clinician–patient relationship. The dilemmas of mass quarantines need to be carefully examined, as their effects on numerous health and psychosocial variables appear to be far-reaching. [ABSTRACT FROM AUTHOR]

The Child-Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) survey is a validated measure of paediatric inpatient experience. The study objective was to determine which survey questions were most correlated with respondents' overall rating of care. Knowing which questions are most important may provide valuable insights for developing targeted quality improvement initiatives. Methods: Within 6 weeks of discharge, 3,389 telephone surveys were completed by parents/guardians of children who were hospitalized for at least 24 hours. The survey was comprised of 66 questions, with responses based on Likert-scales. One survey question asked respondents to rate the overall care that their child received on a scale from 0 (worst care) to 10 (best care). The correlation between the overall rating of care and each survey measure and question was then examined using Spearman correlation coefficients. All survey questions were normalized to a 100-point score (0=worst, 100=best). Results: Questions on provider coordination and nursing care were most correlated with overall experience. Quietness of hospital room (r=0.19, P<0.001), and keeping families informed in the emergency room (r=0.12, P<0.001) showed poor correlation. Correlation with overall experience was strongest for the 'communication with nurses' domain (r=0.46, P<0.001). Conclusions: To our knowledge, this is the first study which examines the correlation of individual questions of the Child-HCAHPS to overall rating of care within a Canadian context. Our results suggest that our large health care organization may attain initial inpatient experience improvements by focusing upon personnel-based initiatives, rather than physical attributes of our hospitals. [ABSTRACT FROM AUTHOR]

Given barriers of patient-centred care (PCC) among physicians and trainees, this study assessed how medical schools addressed PCC in curriculum. The authors used content analysis to describe PCC in publicly-available curriculum documents of Canadian medical schools guided by McCormack's PCC Framework, and reported results using summary statistics and text examples. The authors retrieved 1459 documents from 16 medical schools (median 49.5, range 16–301). Few mentioned PCC (301, 21.2%), and even fewer thoroughly or accurately described PCC. Significantly more clerkship versus pre-clerkship (24.0% vs 12.6%, p < 0.00001), and elective compared with core course descriptions (24.7% vs 14.9%, p < 0.00001) mentioned PCC. The domain of foster a healing relationship was common (79.0%) compared with other domains: address concerns (16.5%), exchange information (14.9%), enable self-care (10.4%), share decisions (4.5%), and manage uncertainty (1.3%). Overall, few documents mentioned or described PCC or related concepts. This varied by school, and was more frequent in clerkship and elective courses, suggesting that student exposure may be brief and variable. Thus, it remains unclear if medical students are fully exposed to what PCC means and how to implement it. Future research is needed to confirm if PCC content in medical curriculum is lacking. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. Methods: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. Results: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. Discussion: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered. [ABSTRACT FROM AUTHOR]

Background: Some jurisdictions restrict primary care physicians' daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods: Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians' daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results: People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions: People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians. [ABSTRACT FROM AUTHOR]

Objectives: Patients adapt to cancer through self‐management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient–provider collaboration during radiotherapy and examine associations among patient–provider collaboration, self‐management and well‐being. Methods: An observational, cross‐sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one‐time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self‐management and well‐being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient–nurse and patient–oncologist collaboration. Results: Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient–nurse and patient–oncologist collaboration models, where collaboration predicted one self‐management aspect, and both physical and mental well‐being. Conclusion: During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self‐management skills. Initiatives to strengthen patient–provider relationships and support self‐management should be developed and applied to interprofessional‐cancer‐care teams. Impact: This is the first known study to empirically support the links among patient–provider collaboration, self‐management and patient outcomes. The study results can enhance practice, research and education. [ABSTRACT FROM AUTHOR]

Background: Many individuals with intellectual disabilities and their caregivers struggle to provide accurate and complete information to healthcare providers. Method: The present authors provided personal medical information cards (PMICs) containing contact and medical information to 52 Canadian adults with 22q11.2 deletion syndrome, a genetic condition associated with intellectual disability. The authors invited them and/or their caregivers to complete a user satisfaction survey concerning usage of the card. Results: Forty‐eight (92%) patients or their caregivers completed the survey. Twenty‐two (46%) respondents used the PMIC over a median of 8 months during encounters with doctors and other professionals, and a majority of these used it more than once. Users reported finding the PMIC "very helpful" (86%) or "helpful" (14%), providing necessary information, speeding up interactions with professionals and helping avoid repeat storytelling. Conclusion: Providing a PMIC to individuals with intellectual disabilities and their caregivers could help improve patient safety and assist in advocacy. [ABSTRACT FROM AUTHOR]

Background: No prior research studied how to implement patient‐centred care (PCC) for migrant women, who face inequities in health‐care quality. This study explored migrant women's views about what constitutes PCC and how to achieve it. Design: We conducted a qualitative study involving three focus groups with migrant women living in Toronto, Canada, recruited from English language classes at a community settlement agency, used constant comparative technique to inductively analyse transcripts and interpreted themes against a published PCC framework. Participants: Twenty‐three migrant women aged 25‐78 from 10 countries participated. Results: Women articulated 28 physician behaviours important to them across six PCC domains: foster a healing relationship, exchange information, address concerns, manage uncertainty, share decisions and enable self‐care. They emphasized the PCC domain of exchanging information, which included 13 (46.4%) of 28 behaviours: listen to reason for visit, ask questions, provided detailed explanations, communicate clearly, ensure privacy and provide additional information. Women said that instead of practising these behaviours, physicians rushed through discussions, and ignored or dismissed their concerns and questions. As a result, women said that physicians may not fully understand their problem, and they may refrain from stating important details or avoid seeking care. Conclusions: This research characterized the lack of PCC experienced by migrant women and revealed specific physician behaviours to optimize PCC for migrant women. Research is needed to develop and evaluate the impact of strategies targeted at migrant women, physicians and health‐care systems to support PCC for migrant women. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) interventions in people with spinal cord injury (SCI) have been limited by a shortage of (1) evidence for sufficient increases in unsupervised PA to improve aerobic fitness and (2) stakeholder involvement in intervention design. Objectives: This study examined the effects of a theory-based PA intervention, developed in collaboration with nearly 300 stakeholders, on PA levels, aerobic fitness, and psychosocial predictors of PA among individuals with SCI. Methods: A randomized controlled trial (RCT) was conducted with 28 men and women with chronic SCI (age 45.0 ± 11.5 years, years post-injury 16.4 ± 12.4). Participants randomized to the intervention group (n = 14) received an introductory personal training session followed by eight weekly 15-min PA behavioral coaching sessions per week. PA was assessed using self-report and accelerometers. Aerobic fitness and psychosocial predictors of exercise were evaluated using an incremental exercise test and survey methods, respectively. Results: At post-intervention, controlling for baseline, the intervention group showed fivefold greater self-reported moderate to vigorous physical activity [mean difference 247.9 min/day; 95% confidence interval (CI) 92.8–403.1; p = 0.026, d = 1.04], 17% greater accelerometer-measured PA (mean difference 3.9 × 105 vector magnitude counts; 95% CI 1.1 × 104–7.7 × 105; p = 0.014, d = 0.31), and 19% higher peak oxygen uptake (VO2Peak; mean difference 0.23 L/min; 95% CI 0.12–0.33; p < 0.001, d = 0.54) compared with the control group. Mean values of psychosocial predictors of PA were also significantly improved in the intervention group compared with controls. Conclusion: To our knowledge, this co-created behavioral intervention produced the largest effect size to date for change in self-reported PA in an RCT involving people with physical disability. This is also the first RCT in people with SCI to demonstrate that a behavioral intervention can sufficiently increase unsupervised PA to improve aerobic fitness. Trial Registration: ClinicalTrials.gov, NCT03111030, 12 April 2017, https://clinicaltrials.gov/ct2/show/NCT03111030?term=NCT03111030&rank=1. [ABSTRACT FROM AUTHOR]

The diffusion of the Web 2.0 has made it possible for patients to exchange on online health communities, defined as computer-mediated communities dedicated to health topics, wherein members can build relationships with other members. It is now acknowledged that online health communities provide users not only with medical information but also with social support with no time or geographical boundaries. However, in spite of their considerable interest, there is still a paucity of research as to how online health communities alter the patient–physician relationship. This research aims at filling this gap and examines how online health communities, while providing users with computer-mediated social support and empowerment, impact the patient–physician relationship. Six hypotheses are proposed and tested. A survey was developed and 328 responses were collected from online patient groups in Canada in 2016. The data were analysed using structural equation modelling. All but one hypothesis are validated. The results show that user computer-mediated social support positively influences user empowerment and participation during the consultation, which in turn determines user commitment to the relationship with the physician. Importantly and contrary to our expectations, user empowerment is found to be significantly but negatively related to user commitment with the physician. [ABSTRACT FROM AUTHOR]

Background Despite growing recognition that shared decision making ( SDM) is central for patient-centred primary care, adoption by physicians remains limited in routine practice. Objective To examine the characteristics of physicians, patients and consultations associated with primary care physicians' SDM behaviours during routine care. Methods A multicentre cross-sectional survey study was conducted with 114 unique patient-physician dyads recruited from 17 primary care clinics in Quebec and Ontario, Canada. Physicians' SDM behaviours were assessed with the 12-item OPTION scale scored by third observers using audio-recordings of consultations. Independent variables included 21 physician, patient and consultation characteristics. We assessed factors associated with OPTION scores using multivariate linear regression models. Results On the OPTION scale, where higher scores indicated greater SDM behaviours, physicians earned an overall mean score of 25.7±9.8 of 100. In the final adjusted regression model, higher OPTION scores were associated with physicians' social participation (involvement in one committee β=5.75, P=.04; involvement in two or more committees β=7.74, P=.01), patients' status as employed (β=6.48, P=.02), clinically significant decisional conflict in patients (β=7.15, P=.002) and a longer duration of consultations (β=0.23, P=.002). Conclusion Physicians' social participation, patients' employment status and decisional conflict and the duration of consultations were associated with primary care physicians' SDM behaviours in routine care. These factors should be considered when designing strategies to implement SDM and promote more patient-centred care in primary care. [ABSTRACT FROM AUTHOR]

Background: Integrative health care (IHC) is an innovative approach to health care delivery. There is increasing focus on and demand for the evaluation of IHC practices. To ensure such evaluations capture their full scope, a clear understanding of the types of outcomes relevant to an IHC approach is needed. The objective was to describe the health domains and health outcomes relevant to IHC practices in Canada. Methods: An online survey of Canadian IHC clinics. Survey questions were informed by the IN-CAM Health Outcomes Database. Descriptive statistics were used to summarize the data. Chi square tests were used to compare responses between clinic types and patient groups served. Results: Surveys were completed by 21 clinics (response rate: 50%). Physical, psychological, social, individualized and holistic were identified as applicable health domains by more than 90% of the clinics. Spiritual domain was the least relevant (70% of clinics). A number of relevant outcomes within each domain were identified. A core set of outcomes were identified and included: fatigue, anxiety, stress, and patient-provider relationship, and quality of life. Clinics with primarily conventional health practitioners were less likely to address overall well-being (p = 0.04), while clinics that provided care to a specialized patient population (i.e. cancer patients) or a mix of general and specialized patients were less likely to address religious practices (p = 0.04) or spiritual experiences (p = 0.007). Conclusions: Outcomes across health domains should be considered in the evaluation of IHC models to generate an understanding of the full scope of effectiveness of IHC approaches. The core set of outcomes identified may facilitate this task. Ethics approval (Ethics ID REB14-0495) was received from the Conjoint Health Research Ethics Board at the University of Calgary. [ABSTRACT FROM AUTHOR]

Sexuality is an important component of overall health and quality of life, yet evidence suggests many aging adults are not discussing sexual health with their physician. The objective of this study was to understand practices of primary care physicians in discussing sexual health with aging patients. An electronic survey was distributed to primary care physicians and family medicine residents at an urban academic hospital in Ontario, Canada. The survey captured the self-reported prevalence of discussions of sexual health with patients aged 50 and above as well as patient, physician and contextual factors influencing the likelihood of discussion. Descriptive statistics were used to summarize the results. Among the 37 physicians who responded to the survey (response rate of 24%), physicians were more likely to discuss sexual health with patients aged 50-75 years than with patient s >75 years with both males (p < 0.0001) and females (p < 0.0001). Most frequently discussed issues with males were erectile dysfunction and sexually transmitted infection, while atrophic vaginitis, bleeding, and pain during intercourse were most often discussed with females. Factors limiting discussion include lack of time, multiple patient comorbidities and a perceived disinterest in sexual activity. 54% of respondents report having adequate knowledge to discuss and manage later life sexual health issues. Proactively discussing sexuality with aging adults may reveal underlying illness and facilitate future help-seeking behaviours. We suggest that primary care physicians have a responsibility to routinely initiate such discussions in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Methods Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. Results The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. Conclusion E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to survey a group of female chiropractors and inquire as to whether or not they had been sexually harassed by their patients. Methods: An online questionnaire was emailed via Survey Monkey to 47 female faculty members at the Canadian Memorial Chiropractic College (CMCC). Respondents were asked if they had been sexual harassed and, if so, the characteristics of the incident(s), their response to it, how serious they perceived the problem to be and whether or not they felt prepared to deal with it. Results: Nineteen of 47 questionnaires were completed and returned. Of these 19, eight respondents reported being sexually harassed by a patient (all male), most commonly within the first 5 years of practice and most commonly involving a 'new' patient. It was rarely anticipated. The nature of the harassment varied and respondents often ignored the incident. Most respondents perceive this to be a problem facing female chiropractors. Discussion: Although this is the first survey of its kind, this is a significant problem facing other healthcare professionals. Conclusions: Among this group of respondents, sexual harassment by patients was a common occurrence. More training on how to handle it, during either a student's chiropractic education or offered as a continuing education program, may be warranted. [ABSTRACT FROM AUTHOR]

Purpose: We present an analysis of various types and strata of complaints received in a geographically isolated tertiary care center over a 2.5-year period. Methods: Research ethics board approval was obtained. The institution described is a closed system with formalized procedures for submitting complaints. All complaints submitted between November 2010 and March 2013 were collected retrospectively. The following data were extracted: type of complainant, nature of the complaint, site or modality of concern, dates in question, and the response. The data were analysed in multiple subgroups and compared with patient and study volume data. Results: The frequency of complaints equalled 0.01% (100/1,050,000). The largest group of those who submitted complaints were patients (69% [69/100]), followed by referring physicians (16%). Examination scheduling and interpersonal conflicts were equally of greatest frequency of concern (21% [21/100]), followed by issues with study reporting (16%). The average time interval between complaint submission and formal address was 15 days. Conclusions: We present a low frequency of complaints, with the majority of these complaints submitted by patients; scheduling and personal interactions were most often involved. Effective communication, both with patients and referring physicians, was identified as a particular focus for improving satisfaction. [ABSTRACT FROM AUTHOR]

Social supports have been shown to affect health in a variety of ways. This paper explores a hitherto ignored avenue linking social supports to health, namely through their influence on having a regular family doctor. We examine the role played by social supports in helping to explain why a significant portion of the Canadian population does not have a regular family doctor even though primary care is fully covered by the public insurer and when having a regular physician is associated with better care and with access to specialists. Five Canadian Community Health Surveys spanning 2001 to 2010 (n = 13,872 to n = 30,814) are employed, containing information on three measures of social support: sense of belonging to the local community, how often an individual has someone to confide in, and number of close friends and relatives. We find evidence of a positive link between social supports, especially sense of belonging, and having a regular doctor. Our results suggest that the benefits associated with policies geared towards community development and strengthening neighborhoods may also include facilitating access to primary-care physicians and, importantly, improving the matching of patients with regular family doctors. [ABSTRACT FROM AUTHOR]

Purpose: Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. Methods: Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. Results: The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. Conclusion: We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues. [ABSTRACT FROM AUTHOR]

The Reassurance Questionnaire (RQ; Speckens, Spinhoven, Van Hemert, & Bolk, (2000) is a self-report measure designed to assess the extent to which patients feel reassured by their attending physicians. While the original RQ was validated in Dutch, the invariance of the factor structure has not been examined in the English version of the RQ. In the current study, the English RQ was completed by university (n = 459), community (n = 244), and medical samples (n = 281). Unlike the original one-factor solution found for the Dutch RQ, a two-factor solution for the English RQ was found for all three samples. The two factors were labeled: (1) Doubt in Physician, and (2) Persistent Health Anxiety. Item loadings were invariant across the community and medical samples. Implications of the findings along with directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap. Methods: All 910 obstetrician-gynecologists licensed in Ontario, Canada, were mailed a true-false survey about lesbian health issues, the Homosexuality Attitudes Scale (HAS), and a demographic survey. Results: Of the 910 surveys, 271 were returned. The mean HAS score was 87.6 (standard deviation [SD] 11.5), indicating an overall positive attitude. The mean knowledge score was 76.0% (SD 9.5), indicating that respondents had adequate knowledge about lesbian health; 22% described their lesbian health knowledge-base as unaware. Most respondents reported lack of education on lesbian health in residency (81%) or medical school (78%). The majority reported a desire for formal education pertaining to lesbian health. There was no correlation between HAS and knowledge scores. Conclusions: Although our results indicate overall adequate knowledge about lesbian health issues, important knowledge gaps were identified. Medical school and residency training curricula should include formal education about lesbian health issues, particularly because most obstetrician-gynecologists report a desire to receive this information. [ABSTRACT FROM AUTHOR]

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients' Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We conducted analyses of transcriptions of 16 family practice consultations in Montreal in the presence of interpreters. Patterns of communication are delineated, grounded in Habermas' Communicative Action Theory and Mishler's operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals; (2) having an interest in the Lifeworld for itself; (3) integrating the Lifeworld with biomedicine; and (4) referring to another professional. Our results suggest physicians engage with patients' Lifeworld and may benefit from both types of interpreters' understanding of the patient's specific situations. A professional interpreter is likely to transmit the patient's Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient's Lifeworld accounts from reaching the physician. Physicians' training should include advice on how to work with all types of interpreters and interpreters' training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning. [ABSTRACT FROM AUTHOR]

Background: Gestational weight gain (GWG) is a major risk factor of poor pregnancy outcomes. Obese pregnant women frequently report bias and discrimination when dealing with health-care providers (HCPs). Effective communication of GWG recommendations may impact risks. Study objectives were to identify perceptions of HCPs in communicating GWG recommendations and to identify potential gaps/opportunities that could be addressed in the development of appropriate materials/programmes. Methods: A survey tool was created using the Theory of Planned Behaviour to capture HCPs' attitudes, behaviours and intentions, using four-point Likert questions. Surveys were distributed to obstetricians/gynaecologists, family physicians, obstetric residents/ fellows, midwives, registered/public health nurses and registered dietitians. Results: Results from 96 surveys show that HCPs agreed discussing GWG was important (100%), beneficial for patient-provider rapport (86%) and best practice (100%); however, most found it unpleasant (68%). Providers have confidence in their skills to provide nutrition advice (71%) and believe they have sufficient training (56%); yet, 31% acknowledged making derogatory comments and indicated that they could improve their communication of GWG (92%). Conclusions: HCPs believe they are providing GWG recommendations in an effective and empathetic manner. While an underlying current of bias/discrimination remains, there is recognition of the importance of more training and access to appropriate tools. [ABSTRACT FROM AUTHOR]

Introduction: We sought to explore the professional, personal and community domains of physician retention in 4 rural communities in Alberta and to develop a preliminary framework for physician retention. Methods: We used a qualitative, collective case study design to study 4 rural communities (cases) in Alberta that retained family physicians for 4 years or longer. Participants included physicians, staff members, spouses and community members. Data collected from interviews, documents and observations were analyzed individually, and similarities and differences across all cases were assessed. Results: A range of factors that could influence physicians' decisions to stay in a particular community were described by participants. Within the professional domain, physician supply, physician dynamics, scope of practice and practice set-up were common across all communities, and innovation, and management and support emerged from some communities. The personal factors, goodness-of-fit, individual choice, and spousal and family support were present in all communities. Four community factors - appreciation, connection, active support, and physical and recreational assets - emerged across all communities, and reciprocity was present in 3 communities. From these data, we developed a preliminary retention framework. Conclusion: Physicians, policy-makers and community members are encouraged to consider the 3 retention domains of professional, personal and community. [ABSTRACT FROM AUTHOR]

Around the world, adults with serious illnesses or chronic conditions account for a disproportionate share of national health care spending. We surveyed patients with complex care needs in eleven countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) and found that in all of them, care is often poorly coordinated. However, adults seen at primary practices with attributes of a patient-centered medical home-where clinicians are accessible, know patients' medical history, and help coordinate care-gave higher ratings to the care they received and were less likely to experience coordination gaps or report medical errors. Throughout the survey, patients in Switzerland and the United Kingdom reported significantly more positive experiences than did patients in the other countries surveyed. Reported improvements in the United Kingdom tracked with recent reforms there in health care delivery. Patients in the United States reported difficulty paying medical bills and forgoing care because of costs. Our study indicates a need for improvement in all countries through redesigning primary care, developing care teams accountable across sites of care, and managing transitions and medications well. The United States in particular has opportunities to learn from diverse payment innovations and care redesign efforts under way in the other study countries. [ABSTRACT FROM AUTHOR]

The article focuses on the study that discusses the healthcare experiences of patients and their families suffering from Huntington disease (HD) which is a fatal neurodegenerative genetic disorder. It also talks about several facts which includes need of healthcare services and emotional supports, lack of knowledge about HD and quality of care to be given to affected families.

In this study, we document cancer healthcare professionals' views of patients' use of cancer‐related Internet information (CRII) and their views on how it informs the ways patients interact with healthcare professionals and services from the point of view of health professionals. We used an interpretive descriptive approach, conducting interviews and focus groups with oncology healthcare professionals (n = 21) at a University‐affiliated western Canadian cancer treatment centre. Data were analysed using thematic analysis. We present an initial understanding of how CRII alters, informs and modulates patients' cancer experience and relates to their interactions with healthcare professionals and services. Findings were synthesised into two thematic categories: pragmatic concerns and priorities; and processes and practices. Healthcare professionals were supportive of patients' needs for more information, particularly at key points in the cancer trajectory when information may be lacking. Participants concurred that CRII could positively benefit patients and, if shared with their healthcare professional, could benefit the patient–healthcare professional relationship. Oncology healthcare professionals provide pivotal information to patients; thus, they are well situated to engage patients in discussions about CRII and incorporate this into patient encounters. These actions may open new lines of communication with patients, strengthen the patient–professional relationship and empower patients to be engaged in their own care. [ABSTRACT FROM AUTHOR]