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Objective To determine whether an education session alleviates distress for both patients with prostate cancer and their partners; and whether their partner's attendance at the session; and disease, treatment, and sociodemographic characteristics affect changes in distress levels. Patients, Subjects and Methods We identified men with untreated prostate cancer at the Vancouver Prostate Centre between February 2015 and March 2016 who agreed to attend our education session. The session consisted of a didactic presentation covering the biology of prostate cancer, treatment options, and side-effects, followed by a private joint session with a urologist and radiation oncologist. We assessed distress using the Distress Thermometer (DT) and compared pre- and post-session distress, and change in distress between patients and partners using matched and unmatched t-tests, respectively. We also assessed pre-session anxiety using the seven-item Generalised Anxiety Disorder measure, and decisional certainty using the Decisional Conflict Scale. Results In all, 71 patients and 48 partners participated in the study. Attending the session led to a significant reduction in the median DT score for patients (4.0–3.0, P < 0.01) and partners (5.0–4.0, P = 0.02). Partners reported higher distress both before and after the session (4.9 vs 3.8, P = 0.03 pre-session and 4.2 vs 3.2, P = 0.03 post-session). The presence of a partner at the session did not affect patients’ pre- or post-session distress or the success of the session at alleviating distress. Sociodemographic and clinical characteristics had little effect on distress levels. Conclusions An interdisciplinary education session is equally effective at alleviating distress for both patients with prostate cancer and their female partners.

A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio = 2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother’s body mass index was 35 or higher at birth (odds ratio = 2.34) and subjects in which the reason for delivery was categorized as “fetal indication” (odds ratio = 2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio = 3.48) and high cumulative dose of synthetic oxytocin (odds ratio = 2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.Lay abstractOxytocin is a hormone naturally produced in the human body that can make the womb (uterus) contract during labor. Manufactured oxytocin is frequently given to mothers in labor to strengthen the contractions or in some cases to start labor. This study compared children with a diagnosis of autism and children without autism to see whether children with autism received more oxytocin during labor. The odds of a child having an autism diagnosis were significantly higher if the delivery was a first-time Cesarean section, if the mother had a body mass index of 35 or higher, or if the reason for delivery were a range of fetal problems that made delivery necessary. It was found that boys who were exposed to oxytocin for longer periods of time during labor and received higher total doses of oxytocin had significantly higher odds of developing autism. There were no significant associations of oxytocin dosing and autism noted in female children. As this is the first study to look at any relationship between the dose of oxytocin received during labor and the odds of developing autism, further study needs to be done to determine whether there is any cause and effect relationship. Thus, at this time, there is no recommended change in clinical practice.

OBJECTIVE: To examine trends in and sociodemographic predictors of the provision of obstetric care within the primary care context among physicians in British Columbia (BC). DESIGN: Population-based, longitudinal cohort study using administrative data. SETTING: British Columbia. PARTICIPANTS: All primary care physicians practising in BC between 2005–2006 and 2011–2012. MAIN OUTCOME MEASURES: Fee-for-service payment records were used to identify the provision of prenatal and postnatal care and deliveries. The proportions of physicians who attended deliveries and who included any obstetric care provision in their practices were examined over time using longitudinal mixed-effects log-linear models. RESULTS: The proportion of physicians attending deliveries or providing any obstetric care declined significantly over the study period (deliveries: odds ratio [OR] of 0.92, 95% CI 0.89–0.95; obstetric care: OR = 0.92, 95% CI 0.89–0.95), and obstetric care provision accounted for a smaller proportion of overall practice activity (OR = 0.96, 95% CI 0.94–0.99). Female physicians had higher odds of including obstetric care in their practices (OR = 1.46, 95% CI 1.27–1.69), and by 2011–2012 had significantly higher odds of attending deliveries (OR = 1.22, 95% CI 1.05–1.38). Older physicians and those located in metropolitan centres were less likely to provide obstetric care or attend deliveries. CONCLUSION: The provision of obstetric care by primary care physicians in BC declined over this period, suggesting the possibility of a growing access issue, particularly in rural and remote communities where family physicians are often the sole providers of obstetric services.

IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.Methods and analysisWe plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.Ethics and disseminationThis study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.

Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents. Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics. Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do. Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice. Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents. Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics. Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do. Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice. &nbsp

PURPOSE Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada. METHODS We used physician-level payments for all primary care physicians practicing in British Columbia from 2006-2007 through 2011-2012. We examined the association between physician demographics and practice characteristics and payment for care in alternative locations and after hours across rural, urban, and metropolitan areas using longitudinal mixed-effects models. RESULTS The proportion of physicians who provided care in alternative locations and after hours declined significantly during the period, in rural, urban, and metropolitan practices. Declines ranged from 5% for long-term care facility visits to 22% for after-hours care. Female physicians, and those in the oldest age category, had lower odds of providing care at alternative locations and for urgent after-hours care. Compared with those practicing in metropolitan centers, physicians working in rural areas had significantly higher odds of providing care both in alternative locations and after hours. CONCLUSION Care provided in non-office locations and after office hours declined significantly during the study period. Jurisdictions where providing these services are not mandated, and where similar workforce demographic shifts are occurring, may experience similar accessibility challenges.

BACKGROUND: Knowing when physicians retire and how they practise in the pre-retirement years is important information for health human resource planning. We identified patterns of retirement for physicians in British Columbia and the determinants of when and how physicians retire. METHODS: For this population-based retrospective cohort study, we used administrative data to examine activity levels and to identify retirements among BC’s practising physicians. We included all physicians who were at least 50 years of age as of March 2006 and who had received payments for clinical services in at least 1 year between 2005/06 and 2011/12. We defined retirement as a permanent drop in monthly payments to less than $1667/month ($20 000/yr). We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models. RESULTS: Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] −4.9 to −3.2) years and 2.3 (95% CI −3.4 to −1.1) years, respectively. We found no difference in retirement age by specialty. We identified 4 patterns of pre-retirement activity: slow decline, rapid decline, maintenance and increasing activity. About 40% of physicians (440/1107) reduced their activity levels by at least 10% in the 3 years preceding retirement. INTERPRETATION: During the study period, physicians in BC — particularly women and those in rural areas — retired earlier than indicated by licensure and survey data. Many physicians reduced their practice activity in the pre-retirement years. These trends indicate that forecasts relying on licensure “head counts” are likely overestimating current and future physician supply.

Reports of a primary care shortage are ubiquitous in Canada and the United States. We used a population-based, retrospective cohort study to examine the extent to which the feminization and aging of the primary care physician workforce and secular trends may contribute to changes in the availability of primary care services. We used billing data for all primary care physicians in British Columbia for the period 2005-12. We used multivariate linear mixed-effects models to study physician remuneration and activity levels. We found limited change in per physician remuneration over the study period. However, numbers of patient contacts and practice sizes (numbers of unique patients) declined by 14 percent and 10 percent, respectively. Although the feminization of the workforce-and, to a lesser extent, its aging-contributed to this decline, the primary driver appears to be a broad trend toward reduced clinical activity over time. To the extent that similar trends are occurring in the United States, the implications of our study for the availability of primary care services beyond Canada are potentially significant.

Objectives The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50–79 with dense breast tissue. Methods A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted. Results Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: −0.0480–0.0359) at a cost of $819 ($ = Canadian dollars) per patient (95% CI: 506–1185), resulting in an incremental cost effectiveness ratio of $565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY. Conclusion There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated.

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of "physician shortages," that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again.

39 Background: The mission of the Prostate Cancer Supportive Care (PCSC) Program at the Vancouver Prostate Centre (VPC) is to provide clinical care focused on the needs of prostate cancer patients and partners. It is comprised of six modules that are administered by medical professionals in urology, radiation oncology, sexual health nurses, registered dieticians, certified exercise physiologist, male pelvic floor physiotherapists, and couples’ counselling. Incorporation of research into daily care provides evidence for these practices, identifies areas for improvement, and tests new approaches. In order to evaluate the interface between the clinical and research programs, we reviewed the metrics of our PCSC program. Methods: Research studies were grouped by type. Screening and enrollment logs were reviewed to tally the total number of patients approached versus enrolled. Reasons for non-participation based on data in our enrollment logs were categorized. Results: Between Feb 2015 and Mar 2019, PCSC Program participated in 22 research studies: 9 therapeutic or lifestyle intervention studies (3 RCTs), 3 observational studies, 2 registries, 1 survey, 1 genetic study, 1 databank , 2 collaborative programmatic studies, 3 “permission to contact” studies (referral to the study team only). 8 of the 22 studies included recruitment of dyads (both patient and their partner or caregiver). Of 1080 consenting patients, 760 (70.4%) enrolled in 1 study, 210 (19.4%) in 2 studies, and 110 (10.2%) in > 3 studies. 583 patients did not consent due to lack of interest (43.7%), not available (21.1%), time constraints (10.3%), travel distance (6.7%). Conclusions: Our data show that a subspecialty supportive care program can provide a rich environment in which to conduct clinical research. We believe that the integration of the research program and personnel into the clinical setting is key to our success. Current on-going studies are evaluating the impact of and patient satisfaction with all PCSC modules.

107 Background: The Vancouver Prostate Centre (VPC) implemented an electronic patient reported outcomes (ePRO) system in April 2017 to collect data on a research protocol in collaboration with University Health Network of Toronto, funded by Prostate Cancer Canada. Responses to ePRO questionnaires collected on iPads were entered into the national PC360 registry initially and a global TrueNorth registry thereafter funded by Movember Foundation. Herein we describe our experience implementing the ePRO system over the last two years. Methods: All patients (pts) with a new diagnosis of localized prostate cancer, either before or just after therapy, were identified using the electronic medical record and were consented in person in clinic. After signing consent, pts were asked to complete ePROs, including EPIC-26, EQ-5D-5L, WHODAS 2.0, and Distress Thermometer, on iPads at designated clinic appointment. Results: Between April 3, 2017-March 31, 2019, 1027 pts were identified as being eligible to complete ePRO: 878 pts (85.5%) consented and completed ePRO at least once. In Year 1 (Apr 2017-Mar 2018), 76.7% of the 1075 planned ePRO questionnaires were completed vs 75% completed of 1258 planned in year 2. Most pts (82.3%,723/878) agreed to be contacted for future research. Of those, 424/723 were recruited to at least one additional registry study. Data for consented pts was missing for 155/878 (17.7%) each year, usually due to difficulty locating the pt to give him the iPad before he left the clinic. In a small percentage of cases, ePRO reports were incomplete due to fluctuating WiFi connectivity, inadequate time to complete the questions before the clinic appointment, refusal, or no show. Conclusions: ePROs for research were successfully implemented into clinical practice in the PCSC program as evidenced by high completion and low refusal rates but required significant manpower due to ethics board requirements. Challenges encountered included: training clinic staff and coordinators to direct pts to the iPad system to minimize missing ePRO assessments, technical difficulties with WiFi connectivity, requirement of ethics board mandating that staff interact with each pt individually to ensure the ePRO assessments are completed. The next step is to incorporate ePROs into clinical practice, in which case consent will not be required.

Background: The incidence of cancer and the cost of its treatment continue to rise. The effect of these dual forces is a major burden on the system of health care financing. One cost containment approach involves changing the way physicians are paid. Payers are testing reimbursement methods such as capitation and prospective payment while also evaluating how the changes impact health outcomes, resource utilization, and quality of care. The purpose of this study is to identify evidence related to physician payment methods’ impacts, with a focus on cancer control. Methods: We conducted a rapid review. This involved defining eligibility criteria, identifying a search strategy, performing study selection according to the eligibility criteria, and abstracting data from included studies. This process was accompanied by a gray literature search for special topics. Results: The incentives in fee-for-service payment systems generally lead to health care services being applied inconsistently because providers practice independently with few systems in place for developing treatment protocols and practice reviews. This inconsistency is pronounced in cancer care because much of the total per patient spending occurs in the last month of life. Some insurers are predicting that this variation can be reduced through the use of prospective or bundled payments combined with decision support systems. Workload, recruitment, and retention are all affected by changes to physician payment models; effects seem to be magnified in the specialist context as their several extra years of training lower their overall supply. Conclusions: Experimentation with physician payment methods has tended to neglect cancer care providers. Policymakers designing cancer-focused physician reimbursement pilot programs should incorporate quality measurement since very ill patients may receive too little treatment when payment models do not cover oncologists’ total costs, e.g., fee-for-service systems whose prices do not account for the possible presence of other diseases.

Objectives Bevacizumab, with 5-Fluorouracil-based therapy, has been shown to prolong survival among patients with metastatic colorectal cancer (mCRC), at a relatively high cost. We evaluated the cost-effectiveness of therapy for mCRC in the eras prior to, and following, the introduction of bevacizumab on a population basis. Methods All patients with newly-diagnosed mCRC in 2003/2004 (the pre-bevacizumab era) and 2006 (the post-bevacizumab era) referred to the British Columbia Cancer Agency were included. A cost-utility/cost-effectiveness analysis was conducted using ‘real-world' data and a Markov approach. Costs were estimated from provincial pharmacy and radiation databases, as well as national inpatient, day-surgery and ambulatory care data sources. Cost per quality adjusted life year gained (QALY) and life year gained (LYG) ratios were calculated, and one-way and probabilistic sensitivity analyses were conducted to test the robustness of the model. Results Median overall survival improved from 15.6 to 19.5months ( p =0.03). For patients in the post-bevacizumab era there was a gain of an average of 0.06QALYs or 0.325LYG at a cost increase of $3791 per patient, resulting in a incremental cost-effectiveness ratio of $62,469/QALY or $15,617/LYG. This improved to $43,058/QALY or $10,764/LYG when the analysis was restricted to patients potentially eligible for bevacizumab. Results were generally robust to changes in model parameters, but were sensitive to the costs of chemotherapy and to differential utilities used in the Markov model. Conclusions The introduction of bevacizumab was associated with increased costs, but cost-effectiveness estimates were in-line with those reported for other cancer therapies.

Background. Among women with surgically removed, high-risk HER-2/neu-positive breast cancer, trastuzumab has demonstrated significant improvements in disease-free and overall survival. The objective of this study is to evaluate the cost-effectiveness of the currently recommended 12-month adjuvant protocol of trastuzumab using a Markov modeling approach and real-world cost data. Methods. A 10-health-state Markov model tracked patients' quarterly transitions between health states in the local and advanced states of breast cancer. Clinical data were obtained from the joint analysis of the National Surgical Adjuvant Breast and Bowel Project and North Central Cancer Treatment Group, as well as from the metastatic study conducted by Norum et al. Clinical outcomes were adjusted for quality of life using utility estimates published in a systematic review. Real cost data were obtained from the British Columbia Cancer Agency and were evaluated from a payer perspective. Costs and utilities were discounted at 5% per year, respectively, for a 28-year time horizon. Results. In the base case analysis, treatment with a 12-month adjuvant trastuzumab regimen resulted in a gain of 1.38 quality-adjusted life years or 1.17 life years gained at a cost of $18,133 per patient. Thus, the cost per QALY gained for the base case is $13,095. Cost per LYG is $15,492. Conclusions. Over the long term, treatment of HER-2/neu mutation positive breast cancer with a 12-month protocol of trastuzumab in the adjuvant setting is predicted to be cost-effective in a Canadian context.

e22057Background: Exercise is an effective management strategy to reduce treatment side effects experienced by prostate cancer survivors (PCS), however, most PCS are insufficiently active. Exercise...

6 Background: Men diagnosed with prostate cancer (PC) face treatment-related sequlae that affect their health and quality of life. The Vancouver Prostate Centre’s (VPCs) Prostate Cancer Supportive Care (PCSC) Program is a comprehensive program for men and their partners that aims to address these challenges. Our objective is to examine registration rates, and the timing/intensity of follow-up with the program, and to explore clinical/sociodemographic factors associated with participation and non-participation. Methods: We used charts for all men who registered with the PCSC program (“registrants”), and a random sample of men who sought PC-related care at the VPC but did not register with the program (“non-registrants”) from Jan 2013-Dec 2016. Registrants were classified as “attenders” (came to PCSC information session/clinic visit), or “non-attenders” (did not attend). We used multivariate logistic regression to quantify the effect of diagnostic, treatment and sociodemographic characteristics on registration. We produced an unadjusted Kaplan-Meier estimator to assess the probability of program attendance over the disease trajectory for those who registered. We used Cox proportional hazards regression to examine impact of the same factors on timing of program participation and a binary logistic model to examine which factors impact program attendance. Results: Preliminary results suggest that 17% of the men who enroll in the program do not subsequently use any services. Program participation continues for more than four years after diagnosis and varies based on Gleason score (Chi Square (CS) = 20.9, p = 0.01), risk score (CS = 11.5, p = 0.02), and clinical T stage (CS = 14.0, p < 0.001). We found no difference participation by age, age at diagnosis, travel distance to clinic or treatment modality. Complete results will be available at the time of presentation. Conclusions: One in six men who register for supportive care do not end up using any despite the program being free of charge. Drivers of non-participation appear to be clinical, with lower risk patients being more likely to chose not to participate, though further investigation is required.

137 Background: Sexual dysfunction and psychological distress are two of the most important unmet supportive care needs of prostate cancer (PC) patients (pts). The Sexual Health Service (SHS) from the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre addresses the sexual recovery needs of PC pts and their partners via education and clinical service. This study explores patient characteristics and needs to better understand SHS utilization. Methods: Data was obtained from patient charts, semi-structured interviews, and patient-reported outcome measures from July 2013-June 2017. Analyses include descriptive statistics and pre-post comparisons via parametric (paired t-tests) or non-parametric (Wilcoxon) tests. Results: Data from 667 pts was analysed. Average age was 65yrs ( SD= 7.3, 43-88yrs) and most were in a relationship (79.6%; mean length = 30.5 yrs, SD= 15.2yrs, 9 mos–68yrs). Appointments were attended with partners (42.3%) or alone (56%) and most pts had undergone surgery for their PC (81.8%). Other treatments included radiation (18.2%), androgen deprivation therapy (13.3%), chemotherapy (1.0%), some had multiple treatments. Average time since end of PC treatment to first SHS appointment was 18 mos ( SD= 25.7mos; range, 0-17yrs). At the first SHS appointment, mean self-reported erectile functioning indicated severe dysfunction (IIEF scores: M =6.39, SD= 5.22). Pts reported significant decreases following PC treatment in: quality of erections, orgasm intensity, sexual desire, partner’s sexual desire, men’s sexual self-view, sexual body image and overall sexual satisfaction ( p’s < .01). Patients also reported lower levels of partner intimacy ( p= .003). At first SHS appointment, 34.5% of patients reported one significant ongoing life stressor, and 23.8% reported more than one. Most common life stressors were health (29.4%), family (23.8%), work (15.3%), relationship (8.8%) and financial (6.9%). Conclusions: Analyses support the need for the SHS, as pts report declines in all realms of sexual wellbeing and ongoing life stressors. Findings improve our understanding of the long-term impacts of PC treatment and guide future treatment offerings.

25 Background: Nutrition is a key part of prostate cancer (PC) survivorship for management of PC, treatment side effects, and overall health. The Prostate Cancer Supportive Care (PCSC) Program is one of only a few PC survivorship programs in Canada that provide nutrition support as part of standard care. A survey was conducted as part of a broader needs assessment to understand health care professionals’ (HCPs) perspectives on nutrition services for men with PC and inform nutrition programs. Methods: An online survey was administered to British Columbia (BC) HCPs caring for men with PC including urologists, radiation oncologists, medical oncologists, registered dietitians and researchers. We used purposive sampling to identify relevant HCPs. HCPs were asked about the importance of oncological nutrition services and how they should be delivered to men with PC. We summarized the percent agreement for each question and across professions then thematically analyzed qualitative data. Results: Of the 56 HCPs invited to participate in the survey, 38 (68%) responded. The majority (61%) agreed that men with PC require more nutritional support. HCPs indicated nutrition services should be offered multiple times throughout survivorship and facilitated through online resources, individual consultations with registered dietitians and consecutive group education sessions. Most (75%) urologists, radiation oncologists and medical oncologists responded that weight management should be the focus for nutrition services, whereas 90% of dietitians responded that nutrition for reducing the risk of PC progression should be the focus. The main themes that arose from the survey suggested that nutrition services should be available in different forms to facilitate individual needs and adapted based on cultural and community settings. Conclusions: HCPs confirm that there is an unmet need for nutrition services for men with PC in BC as existing services prioritize and offer services for cancer-related weight loss. Special consideration should be given to the focus of nutrition service provided, and when and how it is offered. These results will inform the development of additional resources for men with PC to support their nutritional needs.

143 Background: The Prostate Clinic at Vancouver General Hospital recently implemented electronic Patient Reported Outcomes (ePRO) collection from prostate cancer patients (pts). The ePRO system was adopted from the University Health Network, Toronto. Our objective was to review the successes and challenges related to the implementation of the system during its first 6 months of use. Methods: All newly diagnosed pts, those going for a prostate biopsy, and pts booking surgery are asked to complete ePRO on iPads at their clinic appointment. The ePRO includes the EPIC-26, EQ-5D-5L, WHODAS 2.0 questionnaires and the Distress Thermometer. It takes about 4-5 minutes to complete the questions, and consent to be contacted about future prostate cancer research is also requested. Afterwards, pts complete ePROs at each clinic appointment. They receive a report summarizing that day’s responses in the context of previous responses. Results: Between 4-1-17 and 10-16-17, 360 pts were eligible to complete the ePRO. 311/360 pts (86.4%) filled out the ePRO at least once. Of the 49 who didn’t, 24 were missed by the coordinator and 21 were not referred by clinic staff. Only 4 pts (8.2%) refused to answer the ePRO. 18 of the 311 pts only partially answered the ePRO, most often due to the length of the questionnaires. 396 instances of ePRO were completed by 311 pts. WiFi connectivity issues were encountered 30/396 times, which prolonged ePRO completion time, and on 3 occasions resulted in patients refusing to complete ePRO. Conclusions: Implementation of the ePRO system into our urology clinic is a success based on a high completion and low refusal rate, and was organized mainly by a single individual. Challenges include training clinic staff to refer pts to complete ePROs at appropriate times, technical difficulties with WiFi connectivity, and the need to interact with each pt individually, which can be time consuming and result in lost data. Eventually, all pts will be trained to pick up an iPad and complete ePROs prior to each appointment. We found the system straightforward to use, and have updated our iPads with additional questionnaires. It is clear that systems collecting ePROs will become standard practice as technology improves and costs go down.

Since 2011, we’ve worked to create a dialogue between Canada’s journalists and academic health policy experts to enrich the quality and quantity of health policy stories in the Canadian media. We work with a Media Advisory Board made up of journalists and professors of journalism from across the country who let us know what their needs, constraints and objectives are from a journalistic perspective. We also have a network of more than 80 health policy academics who are ready and available to be interviewed by the media and provide a non-partisan, evidence-based perspective from their areas of expertise.Working together, we have created a number of tools for enabling media coverage of health policy issues in Canada, including the preparation of media backgrounders, infographics, posters, podcasts and videos that highlight the evidence, and we conduct webinars, seminars and conferences by and for both journalists and academics alike.But our most successful initiative thus far has been having our academic experts authorOp-Ed articles on health policy issues — highlighting the evidence; they work with a professional editor to follow specific media guidelines, and then we publish the commentaries in the biggest media outlets across the country. The table below illustrates how successful this strategy has been and how receptive media outlets have been to these stories — increasingly so.This book is a selection of Op-Eds we’ve published in media outlets across the country (in both French and English) from October 2013 to October 2014. It thus provides a snapshot of Canadian health policy in the news. It is the third volume in our series (see also Canadian Health Policy in the News (2013) Making Evidence Matter in Canadian Health Policy (2014)) — all made available for free so that they may be read and used widely in educational settings.Topics are organized by chapter headings that address issues such as our challenges with providing Mental Health care; new models for Pharmaceutical Policy and commentaries that flag the myths and truths about our Aging Population and how it will impact health services. Health Care Costs and Spending are always a concern and are raised by many of the essays here including the costs of health human resources and technology. Many of our academics address the ways in which Health is More than Health Care including such issues as poverty, housing and education, while others caution that More Care is Not Always Better. Still other commentaries highlight the dangers and opportunities with Private, For-Profit Solutions to health care funding and delivery, and others compare Canadian and American Health Systems.Collected together, we hope these Op-Eds engage and enrich the dialogue and debate on a health care system that’s so important to Canadians. As we head into a federal election year in 2015, it seems certain that many of these issues will come to the fore, and it serves our democratic system that they be aired and discussed with evidence as the foundation. With journalists and academics in partnership to communicate health policy in the news, we can help navigate the evidence together.

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of “physician shortages,” that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again.

Every year many Canadians go abroad for medical training. About three-quarters of them are unsuccessful applicants to Canadian medical schools. Currently, almost 3600 Canadians are studying medicine at schools in the United Kingdom, Australia, Poland, the Caribbean and elsewhere. Most hope

There is a widespread perception that the increasing proportion of female physicians in most developed countries is contributing to a primary care service shortage because females work less and provide less patient care compared with their male counterparts. There has, however, been no comprehensive investigation of the effects of primary care physician (PCP) workforce feminization on service supply. We undertook a systematic review to examine the current evidence that quantifies the effect of feminization on time spent working, intensity and scope of work, and practice characteristics. We searched Medline, Embase, and Web of Science from 1991 to 2013 using variations of the terms ‘primary care’, ‘women’, ‘manpower’, and ‘supply and distribution’; screened the abstracts of all articles; and entered those meeting our inclusion criteria into a data abstraction tool. Original research comparing male to female PCPs on measures of years of practice, time spent working, intensity of work, scope of work, or practice characteristics was included. We screened 1,271 unique abstracts and selected 74 studies for full-text review. Of these, 34 met the inclusion criteria. Years of practice, hours of work, intensity of work, scope of work, and practice characteristics featured in 12%, 53%, 42%, 50%, and 21% of studies respectively. Female PCPs self-report fewer hours of work than male PCPs, have fewer patient encounters, and deliver fewer services, but spend longer with their patients during a contact and deal with more separate presenting problems in one visit. They write fewer prescriptions but refer to diagnostic services and specialist physicians more often. The studies included in this review suggest that the feminization of the workforce is likely to have a small negative impact on the availability of primary health care services, and that the drivers of observed differences between male and female PCPs are complex and nuanced. The true scale of the impact of these findings on future effective physician supply is difficult to determine with currently available evidence, given that few studies looked at trends over time, and results from those that did are inconsistent. Additional research examining gender differences in practice patterns and scope of work is warranted.

Chapter 19 introduces some fundamental principles of priority setting, critiques the main priority setting approaches in the health sector, and describes some case studies which illustrate how alternative approaches have been employed, beginning with a brief description of the burden and cost of cancer, the introduction of two fundamental principles of priority setting, a critique of the main approaches to priority setting and presenting a readily adaptable way forward for this type of planning activity, and concludes with a discussion of the need to balance economics and ethics when addressing the challenge of setting priorities in cancer control.

169 Background: Regular physical activity (PA) and resistance training (RT) has been shown to improve the health of prostate cancer survivors (PCS), however participation rates are low. To address survivorship needs and support behaviour change, the Prostate Cancer Supportive Care (PCSC) program implemented an Exercise Physiology (EP) clinic using one-on-one exercise counselling. Our objective was to understand the PA and RT characteristics of PCS and examine the effect of an EP clinic on behaviour change. Methods: After enrolment in the PCSC program, PCS were offered a consultation with an Exercise Physiologist. Subsequent consultations occurred at 3, 6 and 12 months. Clinical data collected at each consultation included physical measures, stage of change (TTM), current exercise (GLTEQ and exercise summary), fatigue (FACIT Fatigue and SIFIR), barriers and facilitators to exercise and a safety screening (PAR-Q+). Information was used during the EP clinic to set PA goals and create an action plan for behaviour change, reviewed each visit. Results: 71 PCS, median age 67 (range 50-86) attended the EP clinic between July 2015 and August 2016. 76% had received primary treatment and 24% were on active surveillance. At first consultation, 63% had an at-risk health profile, with an average BMI of 27kg/m2 (overweight), average waist circumference of 102.6cm (high) and insufficient PA, with only 15% meeting both PA and RT guidelines (150 mins moderate-to-vigorous PA and 2 RT sessions weekly). Average reported fatigue was moderate (4/10 on SIFIR). Stage of change (TTM) showed 44% of PCS at pre-contemplation, contemplation or preparation stages and 54% at action or maintenance stages. Self-reported barriers to exercise included lack of time (24%), laziness (19.7%) and fatigue (18%), while exercising with a spouse/friend/team was the main facilitator to exercise (16.9%). Conclusions: The baseline PA and RT levels of EP clinic PCS is similar to population norms in that the majority of PCS are not meeting current guidelines. Our results demonstrate that the implementation of an EP clinic is feasible. Future follow-up of this cohort will evaluate whether the program creates sustainable PA behaviour change in PCS.

Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting.

3623 Background: The addition of bevacizumab (Bev) to either an irinotecan or oxaliplatin- based regimen in the systemic management of metastatic colorectal cancer is associated with a significant ...

Background: Over the past decade, substantial global investment has been made to support health systems and policy research (HSPR), with considerable resources allocated to training. In Canada, signs point to a larger and more highly skilled HSPR workforce, but little is known about whether growth in HSPR human resource capacity is aligned with investments in other research infrastructure, or what happens to HSPR graduates following training. Methods: We collected data from the Canadian Institutes of Health Research, Canada’s national health research funding agency, and the Canadian Association for Health Services and Policy Research on recent graduates in the HSPR workforce. We also surveyed 45 Canadian HSPR training programs to determine what information they collect on the career experiences of graduates. Results: No university programs are currently engaged in systematic follow-up. Collaborative training programs funded by the national health research funding agency report performing short-term mandated tracking activities, but whether and how data are used is unclear. No programs collected information about whether graduates were using skills obtained in training, though information collected by the national funding agency suggests a minority (