Barriers To Care Research Articles

Patients' experiences undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program.

There is urgent need for interventions to facilitate earlier diagnosis of breast cancer in low- and middle-income countries where mammography screening is not widely available. Understanding patients' experiences with early detection efforts, whether they are ultimately diagnosed with cancer or benign disease, is critical to optimize interventions and maximize community engagement. We sought to understand the experiences of patients undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program (WCEDP). We conducted in-person semi-structured interviews with 30 patients in two districts of Rwanda participating in the WCEDP. Patients represented a range of ages and both benign and malignant diagnoses. Interviews were recorded, transcribed, translated, and thematically analyzed. Participants identified facilitators and barriers of timely care along the breast evaluation pathway. Community awareness initiatives were facilitators to care-seeking, while persistent myths and stigma about cancer were barriers. Participants valued clear clinician-patient communication and emotional support from clinicians and peers. Poverty was a major barrier for participants who described difficulty paying for transport, insurance premiums, and other direct and indirect costs of hospital referrals in particular. COVID-19 lockdowns caused delays for referred patients. Although false-positive clinical breast exams conferred financial and emotional burdens, participants nonetheless voiced appreciation for their experience and felt empowered to monitor their own breast health and share knowledge with others. Rwandan women experienced both benefits and burdens as they underwent breast evaluation. Enthusiasm for participation was not reduced by the experience of a false-positive result. Reducing financial, logistical and emotional burdens of the breast diagnostic pathway through patient navigation, peer support and decentralization of diagnostic services could improve patients' experience.

Restructuring lung cancer care to accelerate diagnosis and treatment in patients vulnerable to healthcare disparities using an innovative care model

The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to disparities for vulnerable patients. Our model involved a multi-institutional, multidisciplinary conference to address the complexity of lung cancer care in vulnerable patient populations. The conference was conducted using a process adapted from the problem-solving method entitled FastTrack, pioneered by General Electric. Conference attendees established critical social determinants of health specific to lung cancer and designed a practical care model to accelerate diagnosis and treatment in this population. The resulting care delivery model, the Lung Cancer Strategist Program (LCSP), was led by a lung cancer trained advanced practice provider (APP) to expedite diagnosis, surgical and oncologic consultation, and treatment of a suspicious lung nodule. We compared the timeliness of care, care efficiency, and oncologic outcomes in 100 LCSP patients and 100 routine referral patients at the same thoracic surgery clinic. Patient triage through our integrated care model transitioned initial referral evaluation to a lung cancer trained APP to coordinate multidisciplinary patient-centered care that was highly individualized and significantly reduced the time to diagnosis and treatment among vulnerable patients at high-risk for treatment delay due to healthcare disparities.•To develop the Lung Cancer Strategist Program care model, we used a three-step (Design, Meeting, and Culmination), team-based, problem-solving process entitled FastTrack.•An advantage of FastTrack is its ability to overcome barriers embedded within hierarchal and institutional social systems, empowering those closest to the relevant issue to propose and enact meaningful change.•Under this framework, we engaged a diverse field of experts to assess systemic barriers in lung cancer care and design an innovative care pathway to improve the timeliness and efficiency of lung cancer care in patients at risk for healthcare disparities.

Socioeconomic inequality, health inequity and well-being of transgender people during the COVID-19 pandemic in Nigeria

BackgroundWe aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria.MethodsBetween June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders.ResultsThere were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women.ConclusionsSocioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.

Determinants of Access to Essential Surgery in the Democratic Republic of Congo

IntroductionIn the Democratic Republic of Congo (DRC), the determinants and barriers of essential surgical care are not well described, hindering efforts to improve national surgical programs and access. MethodsA cross-sectional study evaluated access to essential surgery in the Butembo and Katwa health zones in the North Kivu province of DRC. A double-clustered random sample of community members was surveyed using questions derived from the Surgeons OverSeas Surgical Needs Assessment Survey, a validated tool to determine the reasons for not seeking, reaching, or receiving a Bellwether surgery (i.e., caesarean delivery, laparotomy, and external fixation of a fracture) when needed. ResultsOverall, 887 households comprising 5944 community members were surveyed from April to August 2022. Six percent (n = 363/5944) of the study population involving 35% (n = 309/887) households needed a Bellwether surgery in the previous year, 30% (n = 108/363) of whom died. Of those who needed surgery, 25% (n = 78) did not go to the hospital to seek care and were more likely to find transportation unaffordable (P = 0.042). The most common reasons for not seeking care were lack of funds for hospitalization, prior poor hospital experience, and fear of hospital care. ConclusionsAccess and delivery of essential surgery are drastically limited in the North Kivu province of the DRC, such that a quarter of households needing surgery fails to seek surgical care. Poor access was predominantly driven by households’ inability to pay for surgery and community distrust of the hospital system.

Direct and indirect barriers to hypothetical access to care among Canadian forces health services personnel

BackgroundThough research among Canadian Forces Health Services (CFHS) personnel is limited, the literature suggests formal healthcare is underused. Though much research has been conducted on particular barriers (e.g., stigma), examining a breadth of barriers could better inform behavioral interventions. Furthermore, work has yet to examine the indirect effects of barriers through their impact on intentions to access care.MethodsCFHS participants were randomly assigned to complete either a mental health (N = 503) or physical health (N = 530) version of the survey. The survey included questions on the perceived impact of barriers, health-related information (e.g., past access to care), intention to seek care, and two hypothetical scenarios (i.e., pneumonia and back injury or post-traumatic stress disorder and depression) as a proxy of access to care. Multiple regressions using Hayes PROCESS macro were conducted to assess the direct and indirect effects (through intentions) of the barriers on hypothetical access to care.ResultsResults show conflict with career goals barriers were indirectly linked to all health outcomes, and directly linked to mental health outcomes. Treatment preference barriers were directly and indirectly linked to care seeking only for mental health, while resource barriers were directly linked to care seeking only for physical health. Knowledge and ability to access care barriers were directly linked to care seeking for depression and pneumonia.ImplicationsInterventions to improve treatment-seeking should be developed only after the behavioural antecedents are understood, and should focus on combining evidence-based techniques to simultaneously target multiple aspects of the behaviour.

Patient perspective on barriers in type 2 diabetes self-management: A qualitative study.

To explore the perceived barriers in Type 2 Diabetes care among patients with diabetes. Design The study adopted a qualitative exploratory-descriptive design. A semi-structured interview guide was used to collect data from fifteen (15) purposively sampled patients with Type 2 Diabetes at a primary level health facility in the Bono East region. Participants' ages ranged between 42-72 years. The interviews were audio-recorded, transcribed verbatim and analysed using thematic content analysis. Patients with Type 2 Diabetes encountered a range of barriers in diabetes care. These barriers included lack of knowledge of diabetes dietary management strategies, financial constraints, non-compliance to treatment, lack of glucometers, lack of social support, and increased waiting time at health care facilities. The findings indicate that more education on diabetes and dietary management is required as well as social support from peers, family, and non-governmental organizations. Diabetes self-management barriers as revealed by the patients who were participants of this study requires nurses and midwives to ensure that self-management education is well understood by patients and their relatives. This would empower the patients and bring clarity to their confusion about self-care practices.

The Affordable Care Act and child asthma: Lowering health care barriers by raising our voices

BackgroundThis policy discussion addresses the provisions of the Affordable Care Act (ACA) that impact children with asthma. PurposeThe purpose of this policy paper is to inform health care professionals and lawmakers about ACA provisions affecting pediatric asthma care and provide recommendations for policy changes that can improve equitable care for children with asthma. MethodsThe issues addressed involve discrimination, Medicaid policy oversight, quality improvement stategy, data collection, school-based health care funding, accountable care organization reimbursement, and the extension of dependent coverage. DiscussionHealth care policy development that focuses on human rights, and not market valuation, could reduce health inequity among children with asthma. ConclusionPolicy recommendations are presented to improve asthma care for a population that is largely vulnerable due to age, socioeconomic status, and discrimination.

Strengths and challenges with spiritual care: Student feedback from the EPICC Spiritual Care Self-Assessment Tool.

To explore qualitative data from students' self-reported competencies in spiritual care gathered during testing of a student self-assessment tool based on the EPICC Spiritual Care Education Standard. Reflexive thematic analysis of qualitative data from a multinational study on validating a new self-assessment tool. The EPICC Spiritual Care Education Standard for competency in spiritual care was developed to enhance nurses' and midwives' ability to provide spiritual care by creating a baccalaureate education standard for spiritual care competencies. Spiritual care researchers then developed a self-assessment tool to raise student awareness of spirituality and track personal and professional growth in spiritual care competency. The EPICC Spiritual Care Competency Self-Assessment Tool, tested at eight universities in five countries, provided many opportunities for student comments, resulting in rich qualitative data presented here. Themes related to strengths, weaknesses and areas for improvement. Identified strengths were similar across countries: caring attitudes, general knowledge of caring and compassion and good communication skills. Weaknesses/challenges touched on spirituality as overlooked in some cultures but part of life for others, complex questions were hard to understand, and self-assessment tools are common for some and rare for others. Areas for improvement included need for knowledge of religious and other deeply held beliefs and for greater spiritual assessment skills. Similarities across countries related to basic training in communication and compassionate care for nurses globally. Differences lay in the challenges and/or barriers for spiritual care and may relate to cultures within countries and/or university test sites. The Tool raises awareness of spirituality among students and working nurses, providing an accessible way to self-check personal and professional growth in spiritual care competencies, which increases student and nurse capacity to become more knowledgeable and skilled in facilitating spiritual care, thus be role models for students at the intersection of spirituality and health.

Perceived Communication Barriers by Caregivers of Psychiatric Patients.

Caregivers have significant role in effective treatment and recovery during hospitalization. Communication barriers in health care lead to poor treatment outcome of patients and caregiver's dissatisfaction. The aim of study was to find out perceived communication barriers by caregivers of psychiatric patients. A cross-sectional study was conducted among 120 caregivers of psychiatric patients admitted in psychiatric ward of Patan Hospital who were selected by purposive sampling and interviewed using self-developed structured questionnaire. Data was analyzed with SPSS version 16 using descriptive statistics and Chi- square test was used to find out association between personal characteristics of caregivers and extent of perceived communication barriers. Low extent of communication barrier was perceived by 29.17%, great extent by 25.83%, moderate extent by 24.17% and no barriers were perceived by 20.83% caregivers. There was association between duration of hospital stay (p= .006) and extent of perceived communication barrier. Most barriers were due to caregiver's related factors (31.2%) and least perceived barriers were due to environment related factors (17.1%). More than one fourth caregiver's perceived low extent of communication barrier, almost one fourth perceived great extent and less than one fourth perceived moderate extent. There was association between duration of hospital stay and extent of perceived communication barrier. Effective communication may help to minimize perceived barriers resulting in better treatment outcome of patients and caregiver's satisfaction. Most perceived barriers were due to caregiver's related factors like feeling of not being educated, not knowing what to ask with health personnel, unaware of whom to approach and so on for which it is crucial to develop awareness among health personnel while delivering healthcare services. Nurses and doctors need to be effectively trained in communication skills to minimize various perceived barriers resulting in better treatment outcome and satisfaction.

Diabetes stigma and weight stigma among physicians treating type 2 diabetes: Overlapping patterns of bias

AimsAdults with type 2 diabetes (T2D) report experiencing stigma across multiple settings, including stigmatizing interactions with their healthcare providers. However, research examining physician biases toward patients with T2D is scarce. Identifying stigma-related barriers in diabetes care is essential to prevent providers’ biases from impairing health care delivery. This study assessed attitudes towards individuals with T2D and obesity among physicians who treat T2D. Methods: Physicians specializing in internal medicine or endocrinology (n = 205) completed a series of online questionnaires assessing their attitudes towards patients with T2D and obesity, and their attributions of controllability and blame of individuals with T2D and obesity. Results: While 85% of physicians felt professionally prepared and confident to treat patients with T2D, 1/3 reported being repulsed by patients with T2D and view them as lazy (39%), lacking motivation (44%), and non-compliant with treatment (44%). Many witnessed professionals in their field making negative comments about patients with T2D (44%). Physicians endorsed worse levels of bias towards patients with obesity than T2D, but differences were small. ConclusionsFindings highlight the need for stigma reduction interventions for physicians addressing both T2D and obesity. Research assessing the effects of T2D stigma on quality of patient care and health outcomes is needed.

Development and validation of pharmaceutical care barriers scale in Chinese hospitals: a cross-sectional survey.

Introduction: Chinese hospitals still face various barriers to implementing pharmaceutical care. The quantitative instrument for measuring these barriers in China is scarce. This study aims to develop and validate a scale for measuring barriers to providing pharmaceutical care in Chinese hospitals from the perspective of clinical pharmacists. Methods: The scale was developed based on existing literature and qualitative interviews with 20 experts. The scale was included in a small-range pilot survey and then administered to a validation survey in 31 provinces in China. Exploratory factor analysis was used to identify the structure of the scale. Confirmatory factor analysis was applied to verify the structure of the scale and to validate the scale's convergent and discriminative validity. Known-group validity was also examined. Cronbach's alpha examined the internal consistency reliability of the scale. Results: 292 scales were completed and returned for a response rate of 85.6% in the pilot study. Exploratory factor analysis of the scale suggested a five-factor solution (Cognition and attitude, Knowledge and skills, Objective conditions, External cooperation, and Support from managers) accounting for 66.03% of the total variance. 443 scales were sent out in the validation study, with a response rate of 81.0%. Confirmatory factor analysis demonstrated a good fit of the structural model for pharmaceutical care barriers. It showed the scale's good convergent and discriminative validity (The average variance extracted >0.5 and composite reliability >0.7). The scale could also identify the differences in total score among the clinical pharmacists from different hospital grades (p < 0.05). Cronbach's alpha is between 0.658 and 0.896, indicating good internal consistency. Conclusion: From the perspective of clinical pharmacists, this study has developed a scale to assess obstacles to pharmaceutical care. The scale comprehensively encompasses barriers to clinical pharmacists' cognitive and ability-related aspects, hindrances encountered in collaborating with other health professionals and patients, and barriers to the working environment. The reliability and validity have been established through verification.

Understanding the Patient Experience of Foreign-Born Older Adults: A Scoping Review of Older Immigrants Receiving Health Care in Canada.

In Canada, foreign-born older adults (FBOAs) have a higher prevalence of chronic conditions and poorer self-reported physical and mental health than their Canadian-born peers. However, very little research has explored FBOAs' experiences of health care after immigration. This review aims to understand the patient experiences of older immigrants within the Canadian health care system. Employing Arksey and O'Malley's framework for scoping reviews, we searched six databases and identified 12 articles that discussed the patient experience of this population. Although we sought to understand patient experience, the studies largely focused on barriers to care, including: communication difficulties, lack of cultural integration, systematic barriers in health care, financial barriers, and intersecting barriers related to culture and gender.This review provides insight into new areas of research and advocates for strengthened policy and/or programming. Our review also highlights that there is a paucity of literature for an ever-growing segment of the Canadian population.

A novel mobile health application to support cancer surveillance needs of patients and families with cancer predisposition syndromes.

At least 5%-10% of malignancies occur secondary to an underlying cancer predisposition syndrome (CPS). For these families, cancer surveillance is recommended with the goal of identifying malignancy earlier, in a presumably more curable form. Surveillance protocols, including imaging studies, bloodwork, and procedures, can be complex and differ based on age, gender, and syndrome, which adversely affect adherence. Mobile health (mHealth) applications (apps) have been utilized in oncology and could help to facilitate adherence to cancer surveillance protocols. Applying a user-centered mobile app design approach, patients with a CPS and/or primary caregivers were interviewed to identify current methods for care management and barriers to compliance with recommended surveillance protocols. Broad themes from these interviews informed the design of the mobile app, HomeTown, which was subsequently evaluated by usability experts. The design was then converted into software code in phases, evaluated by patients and caregivers in an iterative fashion. User population growth and app usage data were assessed. Common themes identified included general distress surrounding surveillance protocol scheduling and results, difficulty remembering medical history, assembling a care team, and seeking resources for self-education. These themes were translated into specific functional app features, including push reminders, syndrome-specific surveillance recommendations, ability to annotate visits and results, storage of medical histories, and links to reliable educational resources. Families with CPS demonstrate a desire for mHealth tools to facilitate adherence to cancer surveillance protocols, reduce related distress, relay medical information, and provide educational resources. HomeTown may be a useful tool for engaging this patient population.

Perceived barriers among Intensive Care Unit (ICU) nurses in the delivery of nursing care to ICU patients

BACKGROUND: Nurses in the Intensive Care Units (ICUs) routinely provide care to patients and their families nearing the end of their lives. ICU nurses encounter numerous barriers while caring for ICU patients. STUDY AIMS: This study aims to assess the barriers faced by the nurses working in intensive care units while performing their duties. METHODOLOGY: A descriptive cross-sectional study was conducted among intensive care unit nurses at four hospitals. A total of 289 nurses were enrolled in the current investigation. An adapted and modified questionnaire was utilized to collect data. The questionnaire includes demographic information about nurses and questions about nursing care barriers. A five-point Likert scale was used for each aspect, with 1 signifying strong disagreement and 5 denoting strong agreement. RESULTS: In this study, among 289 participants, most of the study participants 176 (60.9%) were in the age group 20–30 years. Most ICU nurses reported the family barrier as the major perceived barrier, with a mean score of 4.01 ± 0.50. The other related barriers include task, environmental, technological, and organizational barriers. CONCLUSION: The current study concluded that ICU nurses faced various perceived barriers while caring for ICU patients. The family barrier was the most prevalent perceived barrier among ICU nurses (mean score 4.01 ± 0.50). Most of the nurses agreed that spending time on explanation to family members (87.9%) was the most common family barrier. Nursing administrators and healthcare policymakers can use the current study findings to improve the healthcare system’s performance.

Assessing antenatal health education given by nurse-midwives in Ile-Ife, Nigeria

Background/Aims In Nigeria, nurse-midwives provide health information and support for pregnant women, as well as treating minor pregnancy-related concerns. Little is currently documented about the contents, methods and supporting structures available for antenatal health education in Osun state. This study explored the health education provided by nurse-midwives during antenatal care, including its contents, methods and resources, as well as barriers and facilitators to its provision. Methods This descriptive study used a checklist and questionnaires to gather data from 189 pregnant women and 14 nurse-midwives from six selected health facilities in Ile-Ife, Osun. Univariate and bivariate analyses were used to assess sociodemographic data, the contents of antenatal care education, education methods and barriers to health education. Results Personal and environmental hygiene, physical activity and exclusive breastfeeding were the main topics taught, with coverage declining by trimester. Lectures followed by a question and answer session were mainly used to educate women, but flip charts, models, audio, video and multimedia were also sparingly used to facilitate learning at antenatal clinics. Conclusions Current health education at antenatal clinics in Ile-Ife reflects the poor periodic training given to nurse-midwives, and a lack of structure to inform the methods and contents of antenatal education. Additionally, there were few resources available to facilitate learning activities. It is recommended that national guidelines on health education are formulated and made available to facilitate unified and accurate education for pregnant women.

Diabetic Foot Care: Knowledge and Practice – A Cross-sectional Study from a Tertiary Care Hospital in Southern India

Background: Diabetes mellitus is one of the major problems in health systems and a global public health threat and diabetic foot ulcers and lower extremity amputations are common, complex, costly, and disabling complications of diabetes. Poor foot care knowledge and practices are important risk factors for foot-related problems among diabetic people. Aims: The aim of the study is to assess the knowledge about foot care, foot care practices, the prevalence and risk factors of diabetic foot and foot-related complications in adult diabetic patients. Settings and Design: The cross-sectional study was conducted in 204 consecutive diabetic patients attending the outpatient department of a tertiary care hospital. Methods: A questionnaire including demographic details, knowledge questionnaire, attitude, and awareness for foot problems based on the Nottingham Assessment of Functional Foot Care Revised 2015 questionnaire was administered. This was followed by a foot examination for various aspects related to foot care and risk stratification. Statistical Analysis Used: Descriptive analysis with frequency distribution for knowledge and practice scores, univariate analysis, and multiple logistic regressions to find significant variables associated with good foot care knowledge and practice scores. Results: About 30.39% had good knowledge score. Rural background (adjusted odds ratio [OR]: 1.98, 95% confidence interval [CI]: 1.08–3.65), poor education status (adjusted OR: 4.63, 95% CI: 1.04–20.54), poor glycemic control (adjusted OR: 1.46, 95% CI: 0.83–2.58), and previous history of foot ulcer (adjusted OR: 3.05, 95% CI: 1.42–6.65) were significantly associated with poor knowledge on foot care. Conclusion: Our study shows that knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, rural background, poor education, and poor glycemic control were significant barriers of foot care. Policymakers should initiate foot care education programs throughout the regional state for increasing awareness about proper foot care practice in diabetic patients to reduce the incidence of complications.

Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey.

To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32g vs. 3109.76 ± 540.89g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.

Cancer Research in Pakistan: Progress, Challenges, and Future Directions

Cancer is a growing public health concern in Pakistan, with rising incidence rates and significant impacts on individuals and communities. In recent years, cancer research in Pakistan has made notable strides in understanding the epidemiology, risk factors, and treatment outcomes of various cancer types. However, numerous challenges persist, hindering progress in cancer control and prevention. Exploring the progress made, acknowledging the challenges faced, and outlining future directions is crucial for advancing cancer research and improving cancer care in Pakistan.&#x0D; In terms of progress, cancer research in Pakistan has provided valuable insights into the burden of different cancer types across various regions. Studies have shed light on the prevalence of common cancers such as breast, lung, and gastrointestinal cancers, enabling targeted interventions and screening programs. Furthermore, collaborative efforts between research institutions and healthcare providers have resulted in improved diagnosis and treatment modalities, with advancements in radiotherapy, chemotherapy, and surgical techniques.&#x0D; Despite these advancements, several challenges persist. Limited access to quality cancer care, particularly in rural areas, remains a significant barrier. Insufficient infrastructure, shortage of skilled healthcare professionals, and financial constraints impede timely diagnosis, treatment, and follow-up care. Additionally, cultural beliefs and social stigmas surrounding cancer often lead to delayed diagnosis and inadequate support for patients and their families. Overcoming these challenges requires comprehensive strategies, including strengthening healthcare infrastructure, training healthcare professionals, and raising awareness about cancer prevention and early detection.&#x0D; Looking ahead, the future of cancer research in Pakistan lies in a multidimensional approach. Enhancing collaboration among researchers, healthcare providers, and policymakers is crucial for effective data collection, research translation, and evidence-based policymaking. Investment in research infrastructure, including molecular and genetic profiling facilities, can facilitate targeted therapies and personalized treatment options. Additionally, fostering international collaborations and partnerships can provide opportunities for knowledge exchange, access to innovative technologies, and clinical trials.&#x0D; Cancer research in Pakistan has made significant progress in understanding the burden of cancer and improving treatment outcomes. However, challenges such as limited access to quality care and cultural barriers must be addressed to ensure equitable and comprehensive cancer services across the country. By investing in research infrastructure, fostering collaborations, and promoting awareness, Pakistan can enhance cancer research capabilities and make substantial strides in cancer prevention, early detection, and treatment. A concerted effort by researchers, policymakers, healthcare professionals, and communities is necessary to combat the growing burden of cancer and improve the lives of individuals affected by the disease.

Implementation Barriers of Multidisciplinary Care in Chronic Kidney Disease Through a CFIR Framework: a Narrative Review

Introduction 37 million Americans suffer from chronic kidney disease, which affects multiple organ systems and requires multidisciplinary care. Multidisciplinary care is an inherently broad and complex topic, and while it is being implemented across health care in the United States and abroad, multidisciplinary care outcomes are poor in this patient population. It is possible that there exist gaps in the literature regarding implementation and replication of multidisciplinary care interventions such that health care practices are unable to fully take advantage of multidisciplinary care publications for chronic kidney disease. This narrative review utilizes the five domains of the Consolidated Framework for Implementation Research to address barriers to multidisciplinary care implementation for chronic kidney disease. Methods A systematized review of peer-reviewed literature including systematic reviews and meta-analyses related to chronic kidney disease and multidisciplinary care through January 1, 2021 was conducted. The five interventions with the most barriers qualitatively identified were analyzed. Results Twelve potentially eligible reviews were identified, and 5 unique systematic reviews and meta-analyses were selected for a total of 48 articles, and ultimately, 5 articles were selected for inclusion. Based on the Consolidated Framework for Implementation Research which includes 5 domains of barriers, we discussed barriers of implementation in all 5 domains within the 5 articles. Discussion Because it is essential that multidisciplinary care for patients with chronic kidney disease be improved and implemented to the fullest extent, researchers should be aware of barriers to implementation and publish results by taking into account the Consolidated Framework for Implementation Research.

Barriers to help-seeking in medical students with anxiety at the University of South Carolina School of Medicine Greenville

Anxiety levels in medical students have been reported as higher than the aged-matched general population, yet medical students are less likely to seek care for mental health issues. Medical students carry high levels of self-stigma about their own mental health and fear the negative consequences of seeking care. The purpose of this study was to examine the student population at the University of South Carolina School of Medicine Greenville (UofSC SOMG) for anxiety levels and determine the self-stigma attitudes this population carries. UofSC SOMG students were surveyed using the GAD7, questions about mental health stigma, and open-ended questions on barriers to mental health care in medical students. Anxiety levels were compared to student responses. 31% of students reported moderate-severe anxiety levels. Stigma was the most frequently listed barrier to care, however, students with moderate-severe anxiety were more likely to report cost as a barrier to care than students with minimal anxiety levels. Despite free and accessible mental health care, medical students at UofSC SOMG still have anxiety at rates higher than the general population. Future work should help to provide interventions to the barriers of care, so medical students can better utilize mental health care resources.