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Background: Recent studies have demonstrated improved outcomes with real‐time patient‐reported outcome questionnaires (PRO questionnaires) using questions adapted for patient use from the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). Outside of the clinical trial setting, limited information exists on factors affecting the completion of PRO questionnaires in routine practice. The primary aim of this prospective cross‐sectional study was to evaluate patient willingness to complete PRO questionnaires on a regular basis and to better understand responder biases to improve patient feedback. Materials and Methods: Patients performing PRO‐CTCAE toxicity and symptom PRO questionnaires in oncology clinics at Princess Margaret Cancer Centre from 2013 to 2016 were assessed for their willingness to complete PRO questionnaires using a nine‐item, tablet‐based acceptability survey. Patient‐reported characteristics (i.e., age, sex, language, marital status, education, occupation, etc.), cancer type, treatment modalities, and health metrics (i.e., Eastern Cooperative Oncology Group) were also collected. Characteristics were evaluated by logistic regression (odds ratios [OR]) using the primary outcome with prespecified levels of significance for univariate (p ≤.10), and additional multivariate (p ≤.05) testing. Results: A total of 1,792 patients (median age 60 years; range 18–97) with various cancer diagnoses were assessed. A greater proportion of female (56%) and white (74%) respondents with an annual household income of <$100,000 (69%) participated. More than half (58%) of respondents were willing to complete PRO questionnaires at every clinic visit, and a high proportion (77%) found utility in reporting physical and emotional feelings to clinicians using PRO questionnaires. In general, patients did not find that PRO questionnaires made clinic visits more difficult (93%). In uni‐ and multivariable testing, patients were more willing to complete sleep‐ and fatigue‐related PRO questionnaires relative to chemotoxicity‐based PRO questionnaires (OR 1.52; p =.012). Patients aged 40–65 versus 18–40 years were also more likely to report high PRO questionnaire acceptability (OR 1.49; p =.025). Additional patient characteristics such as white ethnicity (OR 1.76), Canada as country of birth (OR 1.66), and English language (OR 2.15) relative to other had higher acceptability on uni‐ (p <.001) and multivariable (p <.001) analyses. Patients reporting treatment intent as palliative (OR 0.69; p =.0013) or hematological (OR 0.73; p =.027) were less likely to report high PRO questionnaire acceptability on univariable analysis; however, only palliative patients (OR 0.72) maintained this effect on multivariable testing (p =.012). Patients reporting higher health utility scores (per change in.05) also had significantly increased PRO questionnaire acceptability in uni‐ (OR 1.06; p <.001) and multivariable (OR 1.05; p =.008) analyses. No significant differences in PRO questionnaire acceptability were seen between cancer types, education level, household income, employment status, or treatment modality. Conclusion: Routine assessment using PRO questionnaires is associated with moderate acceptability by patients with cancer. Specific patient characteristics are associated with higher completion willingness. Additional research is necessary to identify factors associated with low acceptability of PRO questionnaires and to develop site‐, ethnicity‐, and treatment‐specific instruments to assess the value of PRO questionnaires for symptom monitoring in clinical practice. Implications for Practice: This study will help to identify the clinical, demographic, and survey characteristics associated with willingness to complete patient‐reported outcome questionnaires regularly in the cancer outpatient setting. regorafenib dosing in patients with metastatic or recurrent gastrointestinal stromal tumors after failure of imatinib and sunitinib. [ABSTRACT FROM AUTHOR]

Background: The avoidable mortality rate is a key indicator of overall health and health care utilization. However, the avoidable mortality rate may differ by the relative remoteness of a community. Avoidable mortality rates specific to remote areas cannot be investigated unless there is a clear geographic classification of remoteness. Therefore, this research uses a newly developed remoteness index to explore the geographic variability of avoidable mortality in Canada. Data and methods: The remoteness index, Canadian Vital Statistics--Death Database (2011 to 2015), and the 2016 Census of Population are used to understand the geographic variability of preventable and treatable mortality rates in Canada. Descriptive and multivariate data analysis techniques are used to test the hypothesis that remoteness is one of the statistically significant predictors of avoidable mortality rates in Canada. Results: There is a clear gradient of preventable and treatable mortality rates by relative remoteness. The preventable and treatable mortality rates are significantly higher in more remote areas than in easily accessible areas. The remoteness index is a good predictor of both preventable and treatable causes of mortality for low-Aboriginal census subdivisions but not for high-Aboriginal census subdivisions in Canada. Interpretation: Both preventable and treatable mortality rates vary significantly by remoteness, despite Canada's universal health care system. The remoteness of Canadian communities may have affected health care delivery and utilization. [ABSTRACT FROM AUTHOR]

Background: Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced., Objective: We sought to identify the health-related decisions and decisional needs of Canadians., Methods: Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100., Results: From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians., Conclusions: During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions., (©Dawn Stacey, Claire Ludwig, Patrick Archambault, Maureen Smith, Monica Taljaard, Meg Carley, Karine Plourde, Laura Boland, Amédé Gogovor, Ian Graham, Daniel Kobewka, Robert K D McLean, Michelle L A Nelson, Brandi Vanderspank-Wright, France Légaré. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 21.03.2023.)

This study examines the perception of health care as reported by respondents from Canada, the United Kingdom, and the United States over three survey periods. Though their health care systems differ widely from each other, they seem to share some degree of mutual challenges and successes. The findings show that health care access, quality care, and reducing waiting time are major challenges. [ABSTRACT FROM AUTHOR]

This study presents the results of an integrated model developed to evaluate the environmental and health impacts of Electric Vehicle (EV) deployment in a large metropolitan area. The model combines a high-resolution chemical transport model with an emission inventory established with detailed transportation and power plant information, as well as a framework to characterize and monetize the health impacts. Our study is set in the Greater Toronto and Hamilton Area (GTHA) in Canada with bounding scenarios for 25% and 100% EV penetration rates. Our results indicate that even with the worst-case assumptions for EV electricity supply (100% natural gas), vehicle electrification can deliver substantial health benefits in the GTHA, equivalent to reductions of about 50 and 260 premature deaths per year for 25% and 100% EV penetration, compared to the base case scenario. If EVs are charged with renewable energy sources only, then electrifying all passenger vehicles can prevent 330 premature deaths per year, which is equivalent to $3.8 Billion (2016$CAD) in social benefits. When the benefit of EV deployment is normalized per vehicle, it is higher than most incentives provided by the government, indicating that EV incentives can generate high social benefits. Image 1 • This study quantified the changes in GHGemissions and air quality impacts of electric vehicles (EV) in Toronto. • The worst-case EV scenario (for electricity supply) can reduce 1500 to 6800Years of Life Lost per year. • The best-case scenario can reduce 330 premature deaths per year, equivalent to $3.8 Billion (2016$CAD). • The economic benefits of EVs under worst-case conditions are higher than current incentives for EV purchase. Main conclusion: Our results indicate that even with the worst-case assumptions for EV electricity supply (100% natural gas), vehicle electrification can deliver substantial health benefits in Toronto region. [ABSTRACT FROM AUTHOR]