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Objective: To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods: A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results: Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results: The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC. [ABSTRACT FROM AUTHOR]

Background: Palliative care educators should incorporate strategies that enhance application into practice by learners. Commitment-to-change is an approach to reinforce learning and encourage application into practice; immediately post-course learners commit to making changes in their practices as a result of participating in the course ("statements") and then several weeks or months later are prompted to reflect on their commitments ("reflections"). Aim: Explore if and how learners implemented into practice what they learned in a palliative care course, using commitment-to-change reflections. Design: Secondary analysis of post-course commitment statements and 4-months post-course commitment reflections submitted online by learners who participated in Pallium Canada's interprofessional, 2-day, Learning Essential Approaches to Palliative Care (LEAP) Core courses. Setting/participants: Primary care providers from across Canada and different profession who attended LEAP Core courses from 1 April 2015 to 31 March 2017. Results: About 1063 of 4636 learners (22.9%) who participated in the 244 courses delivered during the study period submitted a total of 4250 reflections 4 months post-course. Of these commitments, 3081 (72.5%) were implemented. The most common implemented commitments related to initiating palliative care early across diseases, pain and symptom management, use of clinical instruments, advance care planning, and interprofessional collaboration. Impact extended to patients, services, and colleagues. Barriers to implementation into practice included lack of time, and system-level factors such as lack of support by managers and untrained colleagues. Conclusions: Examples of benefits to patients, families, services, colleagues, and themselves were described as a result of participating in the courses. [ABSTRACT FROM AUTHOR]

Context: Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care Core courses aim to equip primary care providers from different professions with core palliative care skills.Objectives: Explore the learning experience of learners from different professions who participated in Learning Essential Approaches to Palliative care Core courses from April 2015 to March 2017.Methods: This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed ended (Likert Scales; 1 = "Total Disagree", 5 = "Totally Agree") and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis non-parametric test tests, and qualitative data underwent thematic analysis.Results: During the study period, 244 courses were delivered; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected "Totally Agree" or "Agree" for the statement "the course was relevant to my practice". A significant difference was noted across profession groups; X2 (4) = 138; p < 0.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X2 = -4.75; p < 0.001), and physicians and social workers (X2 = -6.63; p < 0.001). No significant differences were found between physicians and nurses (X2 = 1.31; p = 1.00), and pharmacists and social workers (X2 = -1.25; p = 1.00). Similar results were noted for five of the other statements.Conclusion: Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions. [ABSTRACT FROM AUTHOR]

From conceptualization to application and evaluation, research is conducted in a context of increasing complexity of disciplines, goals, communities, and partnerships. Researchers often are challenged to demonstrate the rigor of their methods and results to audiences with diverse backgrounds and disciplinary expertise. This article illustrates the benefits of using mixed methods approaches in research designed to address issues in complex research projects. It outlines the implementation of a private, public, and academic partnership, where scientific merit of methods and results was a critical foundation to the development of public policy. The overall goal of the Public Health Leadership Competencies Project (the Project) was to identify public health leadership competencies that could apply to public health practice across the country. This research demonstrates how mixed methods research in public health might be of perceived benefit to complex projects. The Project included challenges and opportunities through multiple phases of data collection and participation of members from each of the seven disciplines in public health (i.e., public health dentists, physicians, dietitians, and nurses, as well as epidemiologists, health promoters, and environmental health inspectors). The discussion addresses challenges of a national project, the complex organizational framework within which we were directed to work, and the lessons associated with using multiple sources of data. [ABSTRACT FROM AUTHOR]

This article presents information on implications of low-energy fractures experienced by women at midlife. In Canada, 1 in 4 women and 1 in 8 men aged 50 years and older have osteoporosis. The risk of low-energy fractures is substantial. Recent research in Canada projects an annual total cost for femoral fractures alone at $10 billion, rising to $20 billion if osteoporotic fractures are included. Prevention, early detection, and cost-effective treatment are possible and recommended to save pain, suffering, and health care costs of osteoporosis and related fractures.

This manuscript explores mid-life women's views of corporeality and the links that these have to their health. Using ethnographic interview techniques, community based interviewers talked with 24 women from rural settings. Our findings suggest that mid-life women have an embodied view of their minds and spirits, and that dualism is generally reserved for thinking about and interacting with the biomedical system. They have a sense of themselves as unique individuals who have a large role in caregiving, multiple other roles, and have luck but also agency in and control of their health and well-being. Motion was a strong theme throughout the interviews. Women embraced this mobility as a characteristic of their well-being as they coped with multiple changes associated with mid-life. In contrast to what some philosophers maintain, women seem to partner both corporeal changes and metaphor. While the sample was limited in scope, the findings support the importance to women's health of understanding the intersections between compositional and contextual variables in various settings. [ABSTRACT FROM AUTHOR]

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease. [ABSTRACT FROM AUTHOR]

Most samples of adult women will contain a significant proportion who have been or are currently in abusive relationships. While past research has linked childhood abuse of girls to adult health concerns, little is known about the process through which women retrospectively reconcile these experiences. This article reports on data collected in an ongoing project on midlife women's health. Twenty-seven of 50 urban, middle-class participants in this phase of the project reported childhood abuse experiences. In the analysis, several aspects of these experiences were identified: definitions of abuse; recontextualizing abuse; responsibility for abuse; abuse avoidance; and experiences of multiple abuse. The women's discourse reflected a number of ideologies that provide a context in which women negotiate their understandings of these childhood experiences. This article provides insight into our understanding of abuse. It addresses the fundamental issue of promoting a worldview that precludes child abuse while leaving adult survivors with options for "moving on." [ABSTRACT FROM AUTHOR]

In this article, the authors provide important insight into the cultural messages that midlife women receive about preventive health care. Data were collected from 24 rural women as part of an ongoing project on midlife women's health. Kleinman's model of the popular and professional health care sectors was used to examine the data. There is clear evidence of clashes between the orientations and expectations of these sectors. Women's experiences reveal some consistent themes that contextualize their preventive health pursuits: time constraints, claims for expert knowledge, salience of family history, and the inclusion of nonallopathic resources as part of the professional realm. At the macrolevel, messages regarding women's responsibility for their health are ubiquitous. At the microlevel, women must negotiate among competing messages and resources and a health care system that often confounds their efforts. These contradictions must be addressed before there are long-term effects on the health of midlife women. [ABSTRACT FROM AUTHOR]

Reports on data collected from women who immigrated to Canada as adults on their day-to-day lives and the factors that affect their health at mid-life. Significance of immigration experience in terms of health and well-being; Strategies to maintain health and cope with health concerns.

Discusses the journey of irritable bowel syndrome (IBS) sufferers in their attempt to understand and manage their illness through documenting patient perceptions of the origin of the illness. Method used in the study; Perceptions of the origin of illness; Length of time to diagnosis; Diagnostic tests for IBS and its treatment.

Presents a substantive record of the work and family experiences of a group of post-retirement aged women. Concept of the feminist political economy that was used to gather the record of post-retirement aged women; Description of the intricate web of resources that provided for the survival and public presentation of the women's families as whole and well.

Summary: In this qualitative secondary analysis, patients with a fragility fracture described needing informal care post-fracture. A significant proportion reported receiving no care or not enough care, often devising strategies to care for themselves. Requesting help from multiple individuals allowed patients to minimize the burden to family and friends. Introduction: In individuals with fragility fractures, our objectives were to examine (1) the experience of receiving informal care post-fracture; and (2) how these care experiences influenced post-fracture recovery and subsequent management of bone health. Methods: A secondary analysis of six primary qualitative studies was conducted. Individuals in the primary studies were English-speaking women and men, 45 years and older, who were living in the community and had sustained a recent fragility fracture or reported a history of previous fragility fractures. Participants who reported at least one instance of needing informal care were categorized as receiving "enough care", "insufficient care", or "no care". Results: Of 145 participants in the primary studies, 109 (75%) described needing informal care after their fracture. Of those needing care, 62 (57%) were categorized as receiving enough care while 47 (43%) were categorized as receiving insufficient or no care. The care needed affected the management of participants' fracture and bone health, including access to health care services. Participants who received insufficient or no care, especially those living alone, devised strategies to care for themselves and often requested help from multiple individuals to minimize the burden to family and friends. Compared with men, women appeared to report needing help with personal daily activities, such as bathing, and transportation to appointments related to bone health. Conclusion: Informal care needs are an additional burden of fragility fractures. Post-fracture interventions should consider the broader context of patients' lives and potentially support the care needs of patients as part of their services. [ABSTRACT FROM AUTHOR]

This article focuses on the framing of women's health services in the context of restructuring dictated by health system regionalization. By examining the archives of a local newspaper and the minutes and documents of one of the key organizations involved in restructuring after regionalization, it was possible to examine the public discourse of the time and subsequently the journalists' and the readerships' understandings of women's health. The evidence suggests that the Salvation Army was instrumental in setting the tone that was taken by the media in framing the issues around the closure and move of its Grace Women's Health Centre. While the Calgary Health Region was successful in bringing the Grace under its mandate and organizational control, it was the Salvation Army, with its highly visible and powerful fundraising arm and its advocacy for holistic women's health, that caught the public's attention. The internal discourse tracked some of the emerging issues, known only to those involved at managerial levels within the health system, but the public discourse kept women centered in decisions regarding the partnership. Women from many constituencies must continue to participate in the public policy realm to ensure that women's health remains an issue in health reform. [ABSTRACT FROM AUTHOR]

Our objective was to ascertain whether the Theory of Planned Behaviour (TPB) explains patient intentions to use antiresorptive medication after a fracture. A qualitative study was conducted with English-speaking members of the Canadian Osteoporosis Patient Network (COPN) who had sustained a fragility fracture at 50+ years of age and were not taking antiresorptive medication at the time of that fracture. Questions during a 1-h telephone interview were guided by the domains of the TPB: they addressed the antecedent constructs regarding antiresorptive medication (attitudes, subjective norms, and perceived behavioural control) as well as intentions regarding antiresorptive medication use. We created a coding template a priori based on the TPB domains and applied this template to the interview data. Twenty-six eligible participants (24 females, 2 males) aged 51-89 completed an interview. The TPB appeared to be predictive of intentions in 19 (73%) participants. In the majority of participants where the TPB did not appear to be predictive (57%), a positive attitude toward antiresorptive medication was the most important antecedent variable in determining intentions. The TPB appeared to be predictive of intentions to use antiresorptive medication among individuals who had experienced a fragility fracture. Attitudes towards medication were especially important. [ABSTRACT FROM AUTHOR]

This qualitative study investigated the meaning of sexuality to palliative patients. Face-to-face interviews were conducted with ten patients receiving care in a tertiary palliative care unit, a hospice or by palliative home care services in their homes. Several themes emerged. Emotional connection to others was an integral component of sexuality, taking precedence over physical expressions. Sexuality continues to be important at the end of life. Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers to expressing sexuality in the hospital and hospice settings. Only one subject had previously been asked about sexuality as part of their clinical care, yet all felt that it should have been brought up, especially after the initial cancer treatments were completed. Home care nurses and physicians were seen as the appropriate caregivers to address this issue. Subjects unanimously mentioned that a holistic approach to palliative care would include opportunities to discuss the impact of their illness on their sexuality. [ABSTRACT FROM AUTHOR]

We explored the role of home telehealth in teenagers' asthma management. Six female teenagers were identified at the asthma clinic of the Alberta Children's Hospital. Qualitative interviews were conducted with the teenagers, their parents and their health care providers before and after they used a home unit to report peak flow and adherence to asthma self-management plans. The equipment was used for three months. Using social cognitive theory allowed five themes to be identified: usability of technology, using technology, technology and personal factors, technology and environmental factors, and technology and behavioural factors. The unsuccessful experience with peak flow data transmission suggested that testing the usability of an approved technology with a particular group of patients is important. Disease status, self-efficacy and asthma management behaviour prior to using the technology, as well as access to healthcare facilities, all seem likely to influence the role of technology in disease management. [ABSTRACT FROM AUTHOR]

The article focuses on the development and improvement in primary care and family medicine research and scholarship capacity in the U.S. and Canada. Topics discussed include the background and significance of medical research capacity, development of research programs, and the transdisciplinary approach to medical specialties and academic disciplines.