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Summary of characteristics from studies investigating the use of knowledge brokers inhealth-related settings. (PDF 238Â kb)

Model specification and implementation. Provides a more detailed overview of the model specification and implementation processes employed in our analyses than is described in the main manuscript. Figure S1. Excess premature deaths by sex and LHIN sub-region, Ontario, 2011â 2015. Map showing the absolute number of excess deaths registered in Ontario LHIN sub-regions between 2011 and 2015 inclusive. Table S1. Results of generalized linear mixed models. Table showing the results of sensitivity analysis using generalized linear mixed models in place of Bayesian hierarchical spatial models. (PDF 1631 kb)

Summary of MetaQAT appraisals from studies investigating the use of knowledge brokers in health-related settings. (PDF 353Â kb)

Rates of homicide, neoplasm, and cardiovascular deaths per 100,000 population and rate ratios by sex and by material deprivation and residential instability indices. (DOCX 22 kb)

Knowledge brokers (KBs) work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. Currently, there is a perceived lack of evidence about the effectiveness of knowledge brokering and the factors that influence its success as a knowledge translation (KT) mechanism. Thus, the goal of this review was to systematically gather evidence regarding the nature of knowledge brokering in health-related settings and determine if KBs effectively contributed to KT in these settings.A systematic review was conducted using a search strategy designed by a health research librarian. Eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Scopus, SocINDEX, and Health Business Elite) and relevant grey literature sources were searched using English language restrictions. Two reviewers independently screened the abstracts, reviewed full-text articles, extracted data, and performed quality assessments. Analysis included a confirmatory thematic approach. To be included, studies must have occurred in a health-related setting, reported on an actual application of knowledge brokering, and be available in English.In total, 7935 records were located. Following removal of duplicates, 6936 abstracts were screened and 240 full-text articles were reviewed. Ultimately, 29 articles, representing 22 unique studies, were included in the thematic analysis. Qualitative (n = 18), quantitative (n = 1), and mixed methods (n = 6) designs were represented in addition to grey literature sources (n = 4). Findings indicated that KBs performed a diverse range of tasks across multiple health-related settings; results supported the KB role as a 'knowledge manager', 'linkage agent', and 'capacity builder'. Our systematic review explored outcome data from a subset of studies (n = 8) for evidence of changes in knowledge, skills, and policies or practices related to knowledge brokering. Two studies met standards for acceptable methodological rigour; thus, findings were inconclusive regarding KB effectiveness.As knowledge managers, linkage agents, and capacity builders, KBs performed many and varied tasks to transfer and exchange information across health-related stakeholders, settings, and sectors. How effectively they fulfilled their role in facilitating KT processes is unclear; further rigourous research is required to answer this question and discern the potential impact of KBs on education, practice, and policy.

Introduction: Distress has become so problematic in oncology that it has been recognized as the “sixth vital sign” implying that distress monitoring should occur as routinely as the monitoring of one’s temperature or blood pressure. The research reported herein investigated the impact of head and neck cancer on levels of distress, commonly reported problems, and perceptions of quality of life in individuals with head and neck cancer and their caregivers. Method: Two distinct studies were conducted; the first explored the patient experience of distress and quality of life while the second assessed the caregiver experience of these same constructs. A prospective, longitudinal research design was employed for the patient study while a cross-sectional design was utilized for the caregiver study. Measurement instruments included: (1) a demographic survey; (2) the Distress Thermometer and Problem Checklist; (3) the EORTC Quality of Life questionnaire (EORTC-QLQ-C30), and (4) the EORTC Head and Neck module (EORTC-QLQ-H&N35), to evaluate quality of life in individuals with head and neck cancer; and (5) the Caregiver Quality of Life-Cancer Scale (CQOLC) to assess quality of life in caregivers. Results: Data indicate that elevated distress can exist at any point along the continuum of care in both individuals with head and neck cancer and their caregivers. Relative to the patient population, distress was most prevalent at diagnosis and length of time following diagnosis had a large effect on perceived distress. Meanwhile 45% of caregiver participants reported clinically significant distress; both caregiver sex and the treatment status (i.e., awaiting treatment, undergoing treatment, completed treatment) of the individual for whom they were providing care influenced perceptions of distress in caregivers. Relative to quality of life, participants in both studies reported elevated burden in three primary domains: role fulfillment, physical functioning, and psychological well-being. Conclusion: Data suggest that perceptions of distress are individualized and heterogeneous in nature. Thus, routine distress screening represents a critical first step in the identification of elevated distress in both those with head and neck cancer and their caregivers. Through early identification and effective management of distress, comprehensiveness of care may be enhanced and long-term outcomes may be optimized.

Catherine C Bornbaum,1 Philip C Doyle,1–3 Elizabeth Skarakis-Doyle,1,2 Julie A Theurer2,3 1Graduate Program in Health and Rehabilitation Sciences, 2School of Communication Sciences and Disorders, 3Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada Background: In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients. Discussion: Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term “health condition” with the more inclusive and dynamic term “health state;” (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life). Summary: It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology. Keywords: ICF, International Classification of Functioning, Disability, and Health, cancer, quality of life, personal factors, health condition

Introduction: This study investigated the impact o f head and neck cancer on distress and quality o f life (QoL). Method: Participants were 37 adults (28 men, 9 women) who had been diagnosed with head and neck cancer within the last 12 months. Measurement instruments included: (1) the Brief Symptom Inventory 18 (BSI-18), (2) the European Organisation for Research and Treatment of Cancer (EORTC) general QoL questionnaire (EORTC-QLQ-C30), (3) the EORTC Head and Neck module (EORTC-QLQ-H&N35), and (4) a brief demographic survey. Results: A significant inverse relationship was detected between QoL and distress suggesting that as level of distress increases, perceived QoL deteriorates. Conclusion: The BSI-18 was found to be an efficient and effective measure o f distress. Based on data obtained, distress remains a pervasive problem for individuals with head and neck cancer and affects both global and specific domains of QoL. As a result, routine distress-screening programs may assist in identifying and responding to problematic distress

Rates of homicide, neoplasm, and cardiovascular deaths per 100,000 population and rate ratios by sex and by material deprivation and residential instability indices. (DOCX 22 kb)