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Over half of all new cancer cases in Alberta are diagnosed among people aged 65+ years, a group that encompasses vast variation. Patient-reported experience measures are routinely collected within Cancer Care Alberta; however, the specific consideration of the needs and concerns of older Albertans with cancer is lacking. In 2021, 2204 adults who had received treatment at a cancer centre in Alberta completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). In this study, we explored the age differences in satisfaction across six dimensions of person-centred care and in the proportions of unmet needs across eight types of issues, with specific attention to older adults. Using three age groups (18–39, 40–64, 65+), only the physical comfort dimension showed significantly lower satisfaction among those aged 65+ years. Using five age groups (18–39, 40–64, 65–74, 75–84, 85+), significantly lower levels of satisfaction were found related to ‘physical comfort’ for those aged 65–74 and 75–84, ‘coordination and continuity of care’ for those aged 75–84 and 85+, and ‘information, communication, and education’ for those aged 85+. Therefore, grouping together all older adults aged 65+ years obscured lower levels of satisfaction with some dimensions of person-centred care among those aged 75–84 and 85+ years. Unmet needs generally increased with age for all types of issues, with significant differences across age groups for emotional, financial, social/family, and sexual health issues. The lower levels of satisfaction and higher proportions of unmet needs call for tailored interventions to promote optimal care experiences and outcomes among older adults receiving cancer care in Alberta and their families.

Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64–62.8) and 10 (OR = 7.90, 95% CI 1.69–38.2); palliative intent radiation (OR 3.87, 96% CI 1.46–11.1); and last review appointment (OR 6.22, 95% CI 1.84–23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47–91.1), nausea (OR 15.7, 95% CI 1.51–412), shortness of breath (OR 7.97, 95% CI 1.20–63.7), and anxiety (OR 6.69, 95% CI 1.58–31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients’ symptoms.

Oncology programs across Canada are reaching capacity as more Canadians are diagnosed with and treated for cancer each year. There is an increasing need to share care with family doctors, however it is unclear how this type of care impacts patient experiences, particularly while receiving active treatment. Retrospective data from the 2021 Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in Alberta, Canada was used in this study. A unique question on the Alberta survey asks patients about their family doctor’s involvement during their cancer care. Patient satisfaction across the six domains of person-centred care on the AOPSS was analyzed based on how involved a patient’s family doctor was. Compared to patients who indicated their family doctor was “Not involved”, patients with “Very involved” family doctors had significantly higher satisfaction scores in all six domains of care. The three domains which showed the largest positive impact of family doctor involvement were: Coordination & Integration of Care, Emotional Concerns, and Information, Communication & Education. The results demonstrate that involving family doctors in cancer care can be beneficial for patients. Based on the observed satisfaction increases in this study, shared care models may be preferred by many patients. These models of care can also help alleviate strain and capacity issues within cancer programs. The results could be used to support recommendations for cancer care teams to regularly involve and communicate with family doctors, to ensure that patients receive comprehensive and tailored care from all their health care providers.

Objective The cancer program in Alberta, Canada routinely collects patient-reported outcomes using the Edmonton symptom assessment system-revised (ESAS-r). The program recently launched the province's new clinical information system which has expanded functionality, allowing patients to complete symptom questionnaires remotely online, instead of completing a paper form at the clinic. This study aimed to test a modified electronic version of the ESAS-r [(e)ESAS-r] with patients, to assess the feasibility of completion and questionnaire clarity. Methods Staff, patients, and other stakeholders worked to create modified definitions for ESAS-r symptoms, to aid in patient understanding. Patient and family advisors were recruited to test the questionnaire. Participants completed an online mock-up of the (e)ESAS-r and answered questions about technical issues. One-to-one cognitive interviews were held to discuss each symptom definition in detail. Modifications were made based on the feedback and a second round of interviews was held to finalize the wording. Results In total, 19 patients and 7 family advisors participated. All but one (96.2%) completed the questionnaire without assistance and had no technical issues. Participants requested certain wording modifications and that definitions be added for all symptoms for consistency. Very few participants reported any confusion with the final definitions. Conclusions The (e)ESAS-r was tested for clarity and ease of completion and was determined to be suitable for remote online use with ambulatory cancer patients. The enhanced definitions on the new questionnaire were clear to patients and helped ensure they understood the meaning of each symptom they were asked to rate.

As the rates of cancer incidence and survival increase in Canada, more patients are living in the post-treatment survivorship phase of their cancer journey. Identifying cancer survivors’ concerns and unmet needs is important so that health care teams can provide relevant information, supports, and resources. Secondary data analysis was carried out on the Alberta patient sample from the 2016 Pan-Canadian Transitions Study survey, designed by the Canadian Partnership Against Cancer. The top concerns for patients treated for five different cancers were examined descriptively and compared. A question about information that patients received post-treatment was also descriptively analyzed. Binary logistic regressions were conducted for each tumour group, using the top three concerns for each group as outcomes and a variety of demographic factors as independent variables. There were 1833 valid respondents in the Alberta sample. Fatigue and anxiety were top concerns for multiple tumour groups. Most patients received more information about treatment side effects than about signs of recurrence and community resources. Within certain tumour groups, younger patients had higher odds of having concerns, particularly anxiety. Awareness of the common and unique concerns experienced by cancer survivors post-treatment enables health care providers to tailor care and resources to help patients manage their symptoms and concerns. These findings address gaps in knowledge around the cancer survivorship phase and may be applicable to cancer programs and primary care providers in Alberta and beyond.

Background: In 2019, cancer patients comprised over 65% of all individuals who requested and received Medical Assistance in Dying (MAID) in Canada. This descriptive study sought to understand the self-reported symptom burden and complexity of cancer patients in the 12 months prior to receiving MAID in Alberta. Methods: Between July 2017 and January 2019, 337 cancer patients received MAID in Alberta. Patient characteristics were descriptively analyzed. As such, 193 patients (57.3%) completed at least one routine symptom-reporting questionnaire in their last year of life. Mixed effects models and generalized estimating equations were utilized to examine the trajectories of individual symptoms and overall symptom complexity within the cohort over this time. Results: The results revealed that all nine self-reported symptoms, and the overall symptom complexity of the cohort, increased as patients’ MAID provision date approached, particularly in the last 3 months of life. While less than 20% of patients experienced high symptom complexity 12 months prior to MAID, this increased to 60% in the month of MAID provision. Conclusions: Cancer patients in this cohort experienced increased symptom burden and complexity leading up to their death. These findings could serve as a flag to clinicians to closely monitor advanced cancer patients’ symptoms, and provide appropriate support and interventions as needed.

Some New Car Assessment Programs (NCAPs) include pedestrian safety ratings based on crash tests. We compared 2,682 real-world Australasian pedestrian injury outcomes with pedestrian safety ratings provided by the Australasian NCAP within the speed limit areas where the collisions occurred. We found that the risk of a pedestrian fatal or severe (involving hospital treatment) injury was considerably reduced for the safest rated vehicles studied, but only in speed limit areas of 40km/h or less. From the perspective of promoting a safer system for pedestrians, these results imply that both lowered speed limits and a safer vehicle fleet are required.

Abstract Autism spectrum disorder (ASD) impacts an individual’s ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).

Abstract Cancer patients experience numerous distressing symptoms and concerns across the course of their illness, which negatively influence their quality of life. Regardless of cancer type, unmanaged symptoms can lead to adverse downstream consequences. Patient Reported Outcome Measures (PROMs) can be used to inform patient care and lead to targeted symptom management but simply gathering this information does not improve outcomes for the patient. Patient generated information must be easy for the clinicians to access and interpret if it is to be used to inform care delivery in ambulatory oncology facilities. This pragmatic work responded to this need. One Canadian provincial ambulatory oncology jurisdiction implemented digital tracking of PROMs over time in the provincial Electronic Medical Record (EMR) to support full integration of PROMs into standard care workflows and processes. Due to an inability within the EMR for direct patient entry, a hybrid data-entry was designed where the patient completes a paper-based PROM in the waiting room, and after clinical review, a clinician documents this along with their clinical assessment in the EMR. Several digital dashboards were developed which report PROMs data at the micro (individual), meso (clinic) and macro (program) levels. Using PROMs routinely in these provincial practice settings has numerous benefits including enhanced patient-clinician communication, assisting with problem detection, management of symptoms, and improving outcomes for patients. There are over 60,000 unique patients represented in our PROMs database, and over 300,000 unique screening events captured. The PROMs data is now used at all levels of the provincial cancer jurisdiction to provide targeted person centred care (micro), to staff appropriately at a clinic or program level (meso), and for capacity planning for provincial programs (macro). A new provincial EMR is currently being implemented which has an associated patient portal. Based on the success of this work, integration of direct entry of PROMs by the patient prior to the appointment and an associated workflow for symptom management is underway in this jurisdiction.

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects.

Following cancer treatment, individuals can be left with physical, emotional, and practical consequences which influence their quality of life. Cancer survivors frequently require added knowledge and skills to handle the demands of everyday living after treatment. Oncology nurses are in an ideal position to address the needs of cancer survivors. This article describes an online interactive workshop for oncology nurses to introduce Canadian data on unmet needs of cancer survivors, highlight the contribution oncology nurses can make to survivorship care, and introduce a self-learning resource for survivor care. Didactic presentations and small group discussions were used and feedback from participants was positive. Online learning can be an effective approach for learning with international nursing colleagues and could be utilized for nurses with limited access to cancer nursing education.

The Ambulatory Oncology Patient Satisfaction Survey (AOPSS) is a standardized instrument to assess the overall cancer patient experience. This study retrospectively investigated differences in care experiences and satisfaction among ambulatory oncology patients who self-identified as receiving outpatient therapies for curative intent or for symptom or disease control. This cross-sectional study analyzed data from the AOPSS collected between February and April 2019 within the provincial cancer program in Alberta, Canada. There were 2104 participants who returned the survey, representing a 52.7% response rate. This nationally validated survey gathers patient care experiences and satisfaction across six domains of person-centred care. Treatment intent was characterized by adding a new “goal of treatment” question. Statistical analysis was performed using Mann–Whitney U tests and analysis of covariance (ANCOVAs). Cancer patients’ treatment goals were found to be significantly associated with key patient characteristics like age, sex, tumour group, and the locations where they received care. Patients whose self-identified goal of treatment was to cure their cancer reported significantly higher levels of satisfaction and a more positive experience in five out of the six person-centred care domains. Results identify marked differences in satisfaction and experience between these two patient groups even though they both received care in the same ambulatory environments. A better understanding of the experience and satisfaction of non-curative cancer patients could allow for a more holistic and supportive approach to patient care. In addition, an early palliative approach to care is recommended for improved patient outcomes.

CANO/ACIO has long recognized the important role oncology nurses play in improving outcomes for cancer survivors. To ensure oncology nurses have easy access to the updated evidence, as a basis for their practice, CANO/ACIO undertook the important work of updating the CANO/ACIO self-learning modules on survivorship and creating several new ones. This article highlights the current gaps in care experienced by cancer survivors in the months and years after their cancer treatments are completed and the important contributions that nurses can have in improving the quality of survivorship care. It also provides an interactive approach to competency development using the newly revised and rereleased Pan-Canadian Survivorship Manual.

As the landscape of cancer care in Canada evolves, oncology nursing roles are developed to enhance the patient experience and address the changing needs of patients and families. Cancer Patient Navigation (CPN), an oncology nursing role focusing primarily on person-centred care coordination and system navigation, has become integral to providing high-quality cancer care in many Canadian jurisdictions. Since 2016, a national group of oncology nursing leaders have been engaged in convening and catalyzing our understanding of the role of patient navigation in the Canadian cancer context with the purpose of developing a national position statement on CPN. In this paper, we provide a historical analysis of the development of the forthcoming Canadian Association of Nurses in Oncology (CANO) position statement on CPN. We present an analysis of participant feedback from workshops at the 2016, 2017, and 2018 conferences, and meeting minutes from the National working group over this same time period. This paper serves as a concise historical summary of the evolution of CPN in Canada while providing a template for other groups looking to develop a consensus-based position statement.

Au Canada, le paysage des soins du cancer évolue et les infirmières en oncologie sont appelées à jouer de nouveaux rôles afin d’améliorer l’expérience des patients et des familles et de répondre à leurs besoins toujours changeants. L’un de ces rôles, la navigation des patients atteints de cancer (NPC), vise principalement à coordonner les soins centrés sur la personne et à guider les patients dans le système de santé. Dans plusieurs provinces et territoires du Canada, la navigation est devenue essentielle pour offrir des soins de grande qualité aux patients cancéreux. Depuis 2016, des chefs de file des soins infirmiers oncologiques se réunissent au sein d’un groupe national pour synthétiser leur compréhension de la navigation des patients en contexte canadien afin d’élaborer un énoncé de position national sur la NPC. Dans le présent article, nous analyserons l’historique de l’élaboration de l’énoncé de position sur la NPC que publiera prochainement l’Association canadienne des infirmières en oncologie (ACIO/CANO). Nous analyserons également les commentaires des participants aux ateliers tenus dans le cadre des congrès de 2016, 2017 et 2018, de même que les comptes rendus des réunions du groupe de travail national qui ont eu lieu pendant cette même période. Le présent article se veut un sommaire historique concis de l’évolution de la NPC au Canada, ainsi qu’un modèle pour les autres groupes aspirant à rédiger un énoncé de position consensuel.

The COVID-19 pandemic prompted the immediate widespread implementation of virtual care appointments in Cancer Care Alberta (CCA). This study aimed to compare patient experiences and satisfaction with in-person care provided prior to the pandemic and virtual care provided after the COVID-19 outbreak. Surveys were conducted to compare patient satisfaction, using the Your Voice Matters (YVM) experience survey, between patients in the pre-pandemic in-person (baseline) and post-outbreak (virtual) cohorts. Generalized Linear Models (GLMs) with an ordinal logistic link were used, adjusting for self-reported health status and other covariates, to investigate the association between cohort type and patient satisfaction. Despite having higher overall health status, the virtual cohort reported statistically significantly lower satisfaction than the baseline with emotional concerns, referrals and resources, and friend/family involvement in their care. Patients in the virtual cohort were much less likely to have completed a routinely used symptom-based Patient Reported Outcomes (PROs) questionnaire, which may help explain satisfaction differences. The additional stressors brought about by the pandemic, as well as the mode of virtual care delivery, both likely contributed to the lower satisfaction of the virtual cohort as well. Understanding the key differences in experience between the two cohorts will inform the development of a larger virtual care strategy within CCA in the future. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Understanding patient experience is essential to providing high quality, person-centered care. A real-time baseline cross-sectional study was completed to identify gaps in patient experience that can be targeted for quality improvement (QI). This study is part of PROSE (Person-centered Radiation Oncology Service Enhancement), a QI initiative developed to improve patient experience at a tertiary cancer centre Radiation Oncology (RO) Department. Data was collected using the Your Voice Matters (YVM) questionnaire. The YVM captures information on the patient’s last visit, and questions are organized based on dimensions of person-centered care. Recruitment occurred between May and August 2019 in the radiation department. Consecutive patients during the study period were approached to complete the YVM either in reference to their initial consultation or previous treatment appointment. Percent positive scores were calculated for quantitative data and a content analysis was completed for open-text data. Of 512 patients approached, a total of 400 patients participated across tumors groups. Overall, patients highly endorsed positive experiences with feeling respected by their healthcare provider. Contacting the clinic, emotional support and wait times were rated as the least positive components of experience across appointment types and tumors groups. The Lung tumour group demonstrated worse experiences across all domains during treatments compared to all other tumour groups. Gaps and differences in patient experience were demonstrated across appointment types and tumour groups. This study provides direction to effectively develop and implement QI work aimed at improving patient experience. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

BackgroundWith the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients’ experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. ObjectiveThe purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta’s unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. MethodsThis qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. ResultsParticipants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta’s patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants’ broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient–provider relationship. ConclusionsAlthough people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them.

Globally, cancer is increasingly affecting our societies, families and healthcare systems. It is estimated more than 14 million people are diagnosed annually, greater than 8 million people die of cancer each year, and there are more than 32 million people living with and beyond cancer around the world. Complicating these overwhelming statistics is the reality that many countries in the world do not have well developed cancer treatment programs; nor is it consistently recognized that specialized knowledge about cancer and caring for those with cancer is required by nurses.

Abstract Background Likely duration of survival of children described as having cerebral palsy is of considerable interest to individuals with cerebral palsy, their families, carers, health professionals, health economists and insurers. The aim of this paper is to describe patterns of survival and mortality to the sixth decade in a geographically defined population of people with cerebral palsy stratified according to the clinical description of their impairments in early childhood. Methods Identifiers of persons born in Western Australia 1956–2011, registered with cerebral palsy on the Western Australian Register of Developmental Anomalies and surviving at least 12 months, were linked to the Australian National Death Index in December 2014. Patterns of mortality were investigated using survival analysis methods. Results Of 3185 eligible persons, 436 (13.7%) had died. Of that sample the 22% with the mildest impairment had survival patterns similar to the general population. Mortality increased with increasing severity of impairment. Of 349 (75%) with available cause of death data, 58.6% were attributed to respiratory causes, including 171 (49%) to pneumonia at a mean age of 14.6 (sd 13.4) years of which 77 (45%) were attributed to aspiration. For the most severely impaired, early childhood mortality increased in succeeding decades of birth cohorts from 1950s to 1990 with 20% dying by 4 years of age in the 1981–1990 birth cohort; it then decreased for subsequent birth cohorts, 20% mortality not being attained until 15 years of age. However by 20 years of age mortality of the most severely impaired born in the 1991–2000 birth cohort exceeded that of all other birth cohorts. Remaining life expectancies by age to 50 years have been estimated for two strata with more severe impairments. Conclusion For 22% of individuals with cerebral palsy with mild impairment survival to 58 years is similar to that of the general population. Since 1990 mortality for those with severe cerebral palsy in Western Australia has tended to shift from childhood to early adulthood.

The genus Trifolium is one of the largest genera of the legume family Fabaceae with ca. 255 species. The genus is divided into eight sections; the section Trifolium is a major section of the genus, comprising 73 species mainly distributed in the Mediterranean region. We used nuclear ribosomal DNA internal transcribed spacer (ITS) and morphological variation to reconsider the delimitation and phylogenetic relationships of species in the section Trifolium with reference to chromosomal variations. Bayesian analysis of ITS data delimited the species as three clades based on the analysis of ITS sequence and informative indels in combination with morphological variation. The phylogeny of the species by different analyses methods does not support their current delimitation in 17 subsections. The basic chromosome number x = 8 is the number for the genus Trifolium, from which x = 7, 6 and 5 were derived through successive aneuploidy events. With reference to the distribution of these numbers in the species of the section Trifolium, species in clade III and clade II are more evolved than species in clade I.

On October 22, 2019, at the recent CANO/ACIO Annual General Meeting, I joined a very special group of national oncology nursing leaders in Canada; I became a past president of CANO. Being included in this group of accomplished leaders does not yet feel comfortable, but I am sure with time I will grow into it. Not long ago, my energies were focused on figuring out how to be the president, and that turned out pretty well, so I am confident I will adjust.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement project to develop, implement, and evaluate a provincial navigation program spanning 15 sites across over 600,000 square kilometres. This project was selected for two years of funding (April, 2012–March 31, 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process. A series of articles has been created to capture the essence of this quality improvement project, the processes that were undertaken, the standards developed, the educational framework that guided the orientation of new navigator staff, and the outcomes that were measured. This first article in the series focuses on establishing the knowledge base that guided the development of this provincial navigation program and describing the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites. The second article in this series will delve into the educational framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into the newly developed cancer patient navigator roles. The third and final article will explore the outcomes that were achieved through this quality improvement project culminating with a discussion section highlighting key learnings, adaptations made, and next steps underway to broaden the scope and impact of the provincial navigation program.

En 2012, l’agence provinciale du cancer de l’Alberta lançait un projet d’amélioration de la qualité dans le but de créer, de mettre en œuvre et d’évaluer un programme de navigation provincial englobant 15 établissements répartis sur plus de 600 000 kilomètres carrés. Ce projet a été sélectionné pour recevoir un financement de deux ans (d’avril 2012 au 31 mars 2014) de l’Alberta Cancer Foundation (ACF), accordé à la suite d’un processus de subvention améliorée des soins (Enhanced Care Grant). Une série d’articles a été rédigée pour capturer l’essence de ce projet d’amélioration de la qualité, des processus amorcés, des normes élaborées, du cadre éducatif déterminant l’orientation du nouveau personnel navigateur et des résultats mesurés. Le premier article de la série porte essentiellement sur la base de connaissances ayant guidé l’élaboration du programme de navigation provincial et sur la méthodologie employée pour mettre le programme en œuvre dans 15 centres de soins du cancer situés en milieu rural ou en milieu urbain isolé. Le deuxième article de la série approfondit le cadre éducatif conçu pour guider l’acquisition des compétences et le processus d’orientation des infirmières autorisées engagées pour remplir ce nouveau rôle d’infirmières pivots auprès des patients atteints de cancer. Le troisième et dernier article explore les résultats obtenus grâce à ce projet d’amélioration de la qualité et se termine par une section de discussion mettant en lumière les principales leçons retenues, les mesures d’adaptation mises en place, ainsi que les prochaines étapes en cours pour étendre la portée et les effets du programme de navigation provincial.

Online classes have significantly increased over the last 20 years. From a simple asynchronous model to a complex, interactive, live system, they challenge many online students. Based on Knowles’ Andragogy theoretical framework, researchers sought to explore the qualities students need to complete a first term undergraduate online course. Researchers conducted a quantitative exploratory study to identify the effects of offering a multifactor orientation; this was an extra seminar online, focused on organizational skills, goal setting, orientation to the online classroom, and academic support for successfully completing a first term class. Participants at an online university in a first term course agreed to attend a faculty- led, one-hour presentation; this was an extra seminar focusing on organizational skills, goal setting, orientation to the online classroom, and academic support. A total of 25 students volunteered and attended the extra seminar, provided by three faculty members who were experienced in teaching first-term students in a school of business at a large online university. There was a total of six separate classes of students, each attending a first-term, 10-week course, Academic Strategies for the Business Professional. The course is a combination of synchronous live seminars- and other asynchronous interactive exercises, focusing on providing a foundation for secondary learning. Students in three of those classes were invited to participate. Three faculty members randomly selected a section of this course prior to the beginning of a new term. Once the term started, the faculty, during the first regular live seminar, invited their respective students to the selected treatment class. A total of 144 students were still on the roster at the end of the courses. Of those, 25 were male (17%). There were only 35 males in all the classes, 24% of the total number of students, so the percentage of males in the treatment group was less than the number of males in all the courses. The average number of males (25%) are enrolled in the school. There was no compensation for attending the extra seminar and an IRB approved the study. The students in the treatment groups were told that they could drop out of the study at any time without penalty and this was detailed in the signed consent form, using Survey Monkey. The final grades for students were compared by an instructor who did not teach one of the treatment classes via a single-factor ANOVA to determine if there was any significant difference in the way each instructor graded. With a p-value of .74, no significant difference was found among the three instructors (Table 1). The final grades of students who did not attend the seminar were compared to the final grades of the students who attended the extra seminar via a single-factor ANOVA to determine if there was a difference in the final grades for those who attended the extra seminar versus those who did not. With a p-value of .03, the grades of those who attended the extra seminar were significantly higher than those who did not (Table 2). Though the n was small, this study indicates that students who received additional help, if only a single extra seminar, may have benefited by earning higher final grades than those students who did not receive the additional instructions. The average grade for the students who did not attend the extra seminar was 58.8%; compared to 79.5% for students who attended the seminar. The students in all classes had continued support services through regular emails, announcements, and resources from faculty, after the multifactor orientation. In other words, the only difference in the classes was that some students had the opportunity to attend an extra seminar and some did not.

Australasian fleets have changed substantially over the past decade, with SUVs and light commercial vehicles becoming more popular. These vehicles have been shown in other studies to impose higher fatality risk to pedestrians. For newer vehicles, pedestrian safety may also benefit from international New Car Assessment Program protocols and safety regulation. To quantify such vehicle fleet effects on pedestrian injury severity, this paper analyses pedestrian injury outcomes using Australian crash data. Younger drivers (aged 25 and under) and male drivers were associated with higher severity pedestrian injury. Collisions with commercial vehicles (vans and utility vehicles) and SUVs were associated with higher odds of fatal and serious pedestrian injury than collisions with cars, which is likely to be related to their frontal structure configuration. There was a trend towards better injury outcomes when the vehicle had a more recent year of manufacture, consistent with – but not necessarily attributable to – changes in vehicle design. Trends over the past 15 years were also assessed using crash data from New Zealand and five Australian States. All other factors being equal, increasing proportions of SUVs and commercial vehicles in these fleets will have increased pedestrian injury severity risks. Nevertheless, this was more than counterbalanced by a reduction in injury severity associated with newer vehicles entering the fleets. The strong effects of vehicle factors found in our analysis support assessment protocols and safety regulations that measure the impact of vehicle frontal structure design on pedestrian injury outcomes.

“It is the set of your sails, not the direction of the wind that determines which way we will go.” —Jim Rohn

« C’est le jeu de voiles et non la direction du vent qui détermine la destination. »—Jim Rohn

What is your present role? (What do you do in that role?)I am currently the Lead of Person Centred Care Integration within CancerControl Alberta. In this role, my areas of responsibility revolve around building capacity at point of care to deliver tailored, individualized care to cancer patients across their cancer journey. This has been achieved by designing, implementing and evaluating programs that aim to enhance the person-centred nature of care delivery. The provincial programs currently in my portfolio include cancer patient navigation, survivorship, screening for distress, and patient-reported outcomes.