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Background: Advance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway. Methods: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders. Results: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway. Conclusions: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway. Trial registration: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03508557. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosing most cancers at an earlier stage improves outcomes because treatments are more effective and often less invasive. This study looked at the health patterns of adults enrolled in Alberta's Tomorrow Project before they were diagnosed with cancer to identify factors related to cancers that are caught early or late. These identified factors were then tested in a similar group of adults from the British Columbia Generations Project who also subsequently developed cancer, to see how well they could predict stage at diagnosis. The confirmed health patterns can be used to improve cancer prevention programs and activities to find cancer earlier in people who are at most risk of being diagnosed with late-stage cancer. Risk prediction models for cancer stage at diagnosis may identify individuals at higher risk of late-stage cancer diagnoses. Partial proportional odds risk prediction models for cancer stage at diagnosis for males and females were developed using data from Alberta's Tomorrow Project (ATP). Prediction models were validated on the British Columbia Generations Project (BCGP) cohort using discrimination and calibration measures. Among ATP males, older age at diagnosis was associated with an earlier stage at diagnosis, while full- or part-time employment, prostate-specific antigen testing, and former/current smoking were associated with a later stage at diagnosis. Among ATP females, mammogram and sigmoidoscopy or colonoscopy were associated with an earlier stage at diagnosis, while older age at diagnosis, number of pregnancies, and hysterectomy were associated with a later stage at diagnosis. On external validation, discrimination results were poor for both males and females while calibration results indicated that the models did not over- or under-fit to derivation data or over- or under-predict risk. Multiple factors associated with cancer stage at diagnosis were identified among ATP participants. While the prediction model calibration was acceptable, discrimination was poor when applied to BCGP data. Updating our models with additional predictors may help improve predictive performance. [ABSTRACT FROM AUTHOR]

Introduction: The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. Method: We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. Results: Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. Conclusion: This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible. [ABSTRACT FROM AUTHOR]

Introduction: We sought to assess awareness of, exposure to and interest in general practitioner (GP) surgery and enhanced surgical skills (ESS) among family practice residents in British Columbia, Alberta and Saskatchewan. Methods: We distributed a survey to all family practice residents at 4 universities in BC, Alberta and Saskatchewan. The survey assessed demographic information, awareness of and exposure to GP surgery or ESS during training, and interest in pursuing formal ESS training. Results: We received 174 responses (27.2% response rate). Numerous respondents were unaware of GP surgery (9.9% ± 4.5%) and ESS (17.9% ± 5.7%). Awareness was higher among respondents from rural hometowns (GP surgery and ESS awareness 100% and 94.1%, respectively), and with prior exposure to GP surgery (GP surgery and ESS awareness 96.9% and 95.4%, respectively). A minority (38.2%) had been exposed to GP surgery, with exposure higher in respondents from rural training sites and in their second postgraduate year (72.5% and 47.4%, respectively). A quarter (25.1%) of respondents were considering ESS training. Factors encouraging training included increased procedures, challenging medicine and impact on patient outcomes. The importance of ESS training opportunities and service was rated highly. Conclusion: Many respondents were unaware of ESS as a career option. Exposure to GP surgery during training was associated with increased awareness. Furthermore, exposure fostered interest in this important field. These results may be helpful in the development of formal ESS training programs and in curricula for family practice residency programs. [ABSTRACT FROM AUTHOR]