Care Assistants Research Articles

Understanding the relationship between maternity care providers and middle-class Chinese migrant women in the Netherlands: A qualitative study

ObjectiveThis study aims to provide insights into the formation and the quality of the maternity care provider-woman relationship between midwives, maternity care assistants and middle-class Chinese migrant women in the Netherlands. Designonline in-depth interviews addressing interpersonal trust, women's autonomy in shared decision making and culturally sensitive care Participants46 middle-class Chinese migrant women, 13 midwives and 12 maternity care assistants in the Netherlands FindingsMidwives and maternity care assistants reported challenges interpreting the needs of middle-class Chinese migrant women in care practices while Chinese migrant women experienced receiving insufficient emotional support. Midwives and maternity care assistant tended to attribute women's different preferences for care to culture which reinforced difficulties of addressing women's needs. Middle-class Chinese migrant women experienced a lack of responsive care, feelings of being overlooked, being uncomfortable to express different opinions and challenges in developing autonomy in the shared decision-making process. ConclusionsA trusting relationship, effective communication with maternity care providers, and a culturally sensitive and safe environment could be beneficial for middle-class migrant mothers. Chinese migrant women held ambivalent attitudes towards both traditional Chinese health beliefs and Dutch maternity care values. Each individual woman adopted the practice of the “doing the month” tradition to a different extent. This indicated the need for maternity care providers to recognize women's various needs for more responsive and individualized care, especially for first-time migrant mothers to negotiate their ways through the new healthcare system. Implications for practiceWe suggest a more proactive role for maternity care providers addressing the individual's subjectivity and preferences. Our findings are relevant and applicable for maternity care professionals conducting shared decision making with middle-class and highly educated migrant women living in Western contexts.

The effects of workplace violence on the job stress of health care workers: buffering effects of wellbeing HRM practices

Contemporary research has focused on antecedents, incidences, and consequences of workplace violence in the healthcare sector. However, little is known about the role of HRM in supporting healthcare workers to cope with negative emotions arising from workplace violence. Grounded in the conservation of resources theory, this study examines the moderating effects of wellbeing HRM practices (WBHRM) on the relationship between workplace violence and job stress. We also examine the mediation effects of job stress on the relationship between workplace violence and quality of care. Data were gathered from 254 and 225 (Study 1) aged care workers (nurses and personal care assistants) in Australia and 136 healthcare workers (doctors and nurses) in China (Study 2) across multiple waves. We use a new measure of WBHRM in this paper to test our hypotheses. Results show that the presence of WBHRM practices moderated the relationship between workplace violence and job stress. We also found that job stress mediates the relationship between workplace violence and quality of care. The findings contribute to the HRM literature by providing an innovative WBHRM approach to support health care workers to cope with job stress after they experience workplace violence.

Clinical placement education during the coronavirus disease 2019 pandemic shapes new nurses: A qualitative study

BackgroundMany newly qualified nurses experience transition challenges because they feel unprepared for the reality of the nursing profession owing to the theory-practice gap. Transition challenges amongst newly qualified nurses have profound consequences for the nursing profession and patient care. A detailed and nuanced understanding of the complexity in transition-related challenges during extraordinary conditions like the coronavirus disease 2019 pandemic is needed for newly qualified nurses to remain in the nursing profession. ObjectiveThis study explored the experience of newly qualified nurses entering the nursing profession who had their clinical placement education missed, shortened, or substituted since they had to serve as health care assistants during the coronavirus disease 2019 pandemic. DesignAn exploratory and descriptive study design was used. SettingsWorkplaces for newly qualified nurses. ParticipantsA purposive sample of 10 newly qualified Norwegian nurses working in various clinical placement nursing settings were included. MethodsData were collected in April and May 2022 via individual interviews conducted via Zoom. Thematic analysis was applied to identify themes. Triangulation was employed to ensure trustworthiness. FindingsThree major themes emerged: relational aspects of nursing, practical aspects of nursing, and inadequacies in the pedagogical plan of teaching and learning. The themes indicate that the limited or suspended clinical placement education during the pandemic affected the competence of newly qualified nurses. ConclusionsDuring the coronavirus disease 2019 pandemic, clinical placement education for student nurses was limited or suspended owing to safety concerns. The short clinical placement durations affected the competence of newly qualified nurses, as they lacked exposure to real-world patient care scenarios as in non-pandemic times. Furthermore, our findings indicate that newly qualified nurses’ clinical placement experiences provide important knowledge and insight for educators in terms of education and support for future student nurses going into situations with short clinical placement hours. The conclusion highlights the implications of the findings and recommendations and the need for further support and education for newly qualified nurses after the pandemic. Study registration detailsThe study was approved by the Norwegian Social Data Service (project number 396247). The registration date was 2021–11–04. Tweetable abstractTransition-related challenges became more prominent during the coronavirus disease 2019 pandemic than during non-pandemic times.

Priority measures to prevent infections and maintain residents’ well-being during COVID-19 outbreaks in nursing homes: Consensus among staff and resident representatives determined in an online nominal group technique study

BackgroundCOVID-19 infection prevention measures can negatively impact nursing home residents’ well-being. Society has been concerned about the imbalance between infection prevention and residents’ well-being, and about nursing home residents’ autonomy in COVID-19 policymaking. ObjectiveThis study explores consensus among nursing home staff about which measures they found to be most important in contributing to preventing infections and to maintaining well-being of residents during COVID-19 outbreaks. In addition, this study explores the decision-making processes regarding COVID-19 measures and the involvement of residents or their representatives. DesignMixed methods based on an online nominal group technique. Setting(s)Dutch nursing homes, June–November 2020. ParticipantsManagers, policy advisors, elderly care physicians, psychologists, a spiritual counselor, nurses, care assistants, and resident representatives (N = 35). MethodsFour panels from the viewpoint of infection prevention, and four panels from the viewpoint of well-being were performed with 3 to 7 participants per panel. Participants individually selected the measure they found most important, discussed these measures together in an online conversation, and rated the importance and urgency of these measures during COVID-19 outbreaks on a 5-point Likert scale. The measures that were rated as (very) important and (very) urgent by all members of that panel were defined as ‘prioritized in consensus’. Panels also discussed the decision-making process regarding COVID-19 measures and the involvement of residents or their representatives. These conversations were transcribed verbatim and thematically coded using an inductive approach. ResultsThe infection prevention panels prioritized isolation measures; testing measures; testing and isolation combinations; use of personal protective equipment around (suspected) infected residents; and preparation for outbreaks by COVID-19 outbreak teams. The well-being panels prioritized cohort isolation, testing combined with cohort isolation and with isolation in residents’ rooms, exceptions to visitor bans, maximum numbers of visitors, and registration and accompanying visitors to the residents’ rooms. Resident representatives and staff were dissatisfied with their reduced involvement in policy making during the first months of the COVID-19 pandemic, although they understood that decisions had to be made quickly. ConclusionsStaff and resident representatives should be involved in COVID-19 policy making. According to them, priority COVID-19 measures should include: cohort isolation, testing and isolation combinations, use of personal protective equipment, crisis management by COVID-19 outbreak teams, and nursing home visit regulations and instruction of visitors. Combining these measures may be a first step towards packages of COVID-19 measures that better balance infection prevention and maintaining residents’ well-being. RegistrationN/A Tweetable abstractPriority COVID-19 nursing home measures are isolation, testing, testing and isolation combinations, PPE use, preparations by outbreak teams, and visit regulations @wilcoachterberg

Staff's experiences of a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme: A qualitative process evaluation.

To understand participants' experiences with a culturally specific DEmentia Competence Education for Nursing home Taskforce programme within the contexts which was delivered. An exploratory descriptive qualitative approach. Semi-structured individual interviews were conducted within one week with the participants upon their completion of the programme from July 2020 to January 2021. A purposive sample of participants with different demographic characteristics in five nursing homes was recruited to maximize the sample variation. Interviews were audiotaped and transcribed verbatim for qualitative content analysis. Participation was on voluntary and anonymous basis. Four major themes were identified, including perceived benefits of the programme (i.e., enhanced sensitivity to the needs of residents with dementia, increased communication with families of residents with dementia, facilitated guidance on care for residents with dementia), facilitators (i.e., comprehensive content, active learning, qualified trainer, intrinsic motivation and organizational support), barriers (i.e., busy working schedules, discrimination against care assistants' learning capability) and suggestions for improvement. The results suggested the acceptability of the programme. The participants positively appraised the programme in enhancing their dementia-care competence. The facilitators, barriers and suggestions identified provide insights on improving programme implementation. The qualitative findings from the process evaluation are pertinent to support the sustainability of dementia competence programme in nursing home setting. Future studies could address the modifiable barriers to enhance its effectiveness. This study was reported in adherence to the Consolidated criteria for reporting qualitatve studies (COREQ) checklist. Nursing-home staff was involved in intervention development and delivery. The educational programme could be integrated into the routine practice in nursing homes to improve staff's dementia-care competence. More attention should be paid on the educational needs of the taskforce when implementing the educational programme in nursing homes. Organizational support is the precondition for the educational programme and cultivates a culture for practice change.

FUNCTIONAL STATUS AMONG PATIENTS WITH STAGE III PARKINSON’S DISEASE

Aims Of Study: The purpose of the study was to assess the functional capabilities of patients with Stage III Parkinson's disease (PD). Functional status of PD patients declines due to impaired postural reflexes and characteristic loss of balance which became evident at Stage III thus activities of daily living (ADLs) are compromised as the severity of the disease increases. Methodology: Descriptive case series was conducted on stage III PD patients (n=64). Patients with age ranges from 45 to 75 years were recruited and patients with other neurological issues were excluded. They were assessed using a Functional independence measure scale having reliability 0.95. Results: Out of 64 patients, 75% required minimal assistance and 9.4% required supervision while performing the ADLs. Whereas, 81% of patients need 2 hours of personal care assistance according to burden of care. Limitations & Future Implications: Only functional status of PD patient is determined no exercise regime or intervention were incorporated to assess their impact on the PD patient functional activities. Thus, future studies should be carried out to find the correlation between aerobic exercises and their impact on PD patient level of functional independence. Originality: Information added was all taken from databases and reduced to similarity index and was not submitted to any other journal. Conclusion: Stage III Parkinson’s disease patient required minimal level of assistance while performing tasks of daily living. However, majority of these patients required 2 hours of personal care assistance on average per day to compete with daily living.

Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability.

As more jurisdictions consider legalizing medical assistance in dying or assisted death (AD), there is an ongoing debate about whether AD is driven by socioeconomic deprivation or inadequate supportive services. Attention has shifted away from population studies that refute this narrative, and focused on individual cases reported in the media that would appear to support these concerns. In this editorial, the authors address these concerns using recent experience in Canada, and argue that even if we accept these stories at face value, the logical policy response would be to address the root causes of structural vulnerability rather than attempt to restrict access to AD. In terms of concerns about safety, the authors go on to point out the parallels between media reports about the misuse of AD and reports of wrongful deaths due to the misuse of palliative care (PC) in jurisdictions where AD was not legal. Ultimately, we cannot justify having a different response to these reports when they apply to AD instead of PC, and nobody has argued that PC should be criminalized in response to such reports. If we are skeptical of the oversight mechanisms used for AD in Canada, we must be equally skeptical of the oversight mechanisms used for end-of-life care in every jurisdiction where AD is not legal, and ask whether prohibiting AD protects the lives of the vulnerable any better than legalization of AD with safeguards.

Healico—a wound care assistant in your pocket

Non-optimal wound management and late referral to specialised units negatively impacts patient prognosis and quality of life, as well as healthcare costs. Healico is a new mobile application (app), created in the wound care field, in response to the challenges and difficulties encountered by health professionals (HPs) who deal with patients with wounds on a daily basis. This article aims to describe how this new app was developed, how it works, as well as the real-life clinical benefits and evidence supporting its use. The Healico App assists nurses, physicians and other HPs by: supporting a holistic approach to patient management; facilitating wound assessment and documentation, irrespective of where care is provided (primary, specialised or hospital services, in either public or private institutions); and supporting consistent and safe clinical practice, as well as reducing variation in care. It also provides a fast, fluid and secure communication channel, and effective coordination between HPs, supporting early interventions. The app has also been shown to improve therapeutic adherence of patients by promoting inclusive dialogue with them.

The analysis of problems of supporting long-term nursing of individuals who lost their ability to self-care in Russia

The article considers the issues of social assistance of long-term care of individuals who lost ability to self-care. The comparative analysis of established practices of social assistance of long-term care, of legal and financial support of family members implementing such a care in Russia and European countries is presented. The study was carried out using comparative jurisprudence methodology. The analysis of legislative acts of the European countries revealed possibility of including particular legal provisions concerning financing of long-term care and implementing contractual forms of regulation of employment of family members providing such care, in the Russian social welfare system. The study demonstrated inadequate efficiency of the Russian systems of legal protection and social assistance both individuals seeking long-term care and individuals implementing it, as compared with similar systems in the European countries. To improve these systems, it is necessary to recognize legislatively the care of relative who lost the ability of self-serve as labor function liable to payment based on minimum wage rate. To fix legislatively retention of workplace for caregiver for entire period of caring and/or grant him unpaid vacation for long period. It is necessary to adjust both amount of benefits for care of family member who lost ability to self-care and procedure of calculation of amount of pension benefit of caregiver. The study results can contribute to widening scientific and practical professional discussion in the field of public health, health care organization and social work concerning problems of optimization of means and modes of supporting long-term care of persons who lost ability to self-care. The study results can serve as ground for making amendments to national legislation to harmonize legal support of social welfare system and to improve protection of rights of family members caring relative who lost ability to self-care in conditions of forced loss of income.

Стратегии формирования благополучия студенческих семей (по результатам глубинного интервью)

The methodological basis of the research is built within the framework of understanding sociology and the theory of social action by M. Weber. The paper reveals the content of the concept of a prosperous young family, highlights the parameters of the well-being of a student family. The empirical base of the study is the data of indepth interviews (n = 80) conducted with members of student families from 10 regions of Russia. The method of "grounded theory" and the method of reconstructing the life path of the family were used to process the obtained results. The main objective of the study is to identify strategies for the formation of well-being of Russian student families for the implementation of marital and reproductive behavior as well as systematization of problems affecting the decline in well-being. The main problem is financial difficulties of student families. The socio-economic status of a student family depends on many conditions. For example, status of the spouses' parent family, age of spouses, willingness and ability to combine work and study, availability of a separate housing or resources for rent for a young family. In addition to material problems married students have psychological difficulties adapting to new roles. With appearing children affordable and high-quality medical care, assistance in child care, and inclusion of educational organizations in the development of an individual training plan are necessary. Reproductive orientations of students correspond to the practices of goal-oriented and value-rational behavior (with the exception of cases of unplanned pregnancy) because the birth of children is associated with responsibility. It is revealed that the strategies for the formation of well-being of student families are influenced by many factors. Firstly, there is impact of scenarios for the development of premarital relationships. For example, the transformation of youth romantic relationships and youth love into marital relations, effective joint activity, shared values as the basis for marriage, acquaintance in friends' company and at work, acquaintance through social networks, "influence of parents", "need for legal consolidation of relationships", "responsibility for unplanned pregnancy". Secondly, the reproductive attitudes of married families is also significant. Thirdly, there is influence of family measures and demographic policy implemented in the region and the resources of educational organizations for effective assistance to a young family.

Medical Assistance in Dying and Palliative Care: Shared Trajectories.

Medical Assistance in Dying (MAID) and palliative care often have an antagonistic relationship in jurisdictions where both are legal, but the early ethical and legal history of palliative care closely mirrors that of MAID in important ways. Palliative practices that are commonplace today were considered homicide or "medically assisted death" in most jurisdictions until quite recently. Moreover, while many patients request MAID today for reasons that are criticized as "ableist," the same rationale is accepted without comment or judgment when used to justify withdrawal of life support or a discontinuation of life-prolonging therapies. Concerns about factors that undermine autonomous decisions for MAID would apply equally to routine palliative care practices. By the same token, palliative care exists because no field in medicine is able to fix every problem it encounters. It is ironic, therefore, that some palliative care providers oppose MAID with the hubristic argument that we can relieve all forms of suffering. Palliative care providers may choose not to participate in MAID, but palliative care and MAID do not have to be mutually exclusive and are often complementary and synergistic for patients and families.

Incidência da síndrome de burnout no profissional em enfermeiro durante o período de pandemia da COVID-19 na Grande Vitória-ES

The research aims, through the collection of theoretical and sociodemographic data, to demonstrate the incidences of the worsening of the Burnout syndrome during the Covid 19 pandemic. It is a cross-sectional study, exploratory and descriptive, carried outin public hospitals , philanthropic and private institutions in Greater Vitória in the municipalities of Vitória, Serra, Cariacica and Vila Velha. The research aimed to investigate the incidence of Burnout Syndrome in nurses working in emergency rooms andIntensive Care Units in hospitals in four municipalities in Greater Vitória. The incidence of Burnout Syndrome in the survey was 26% (13) for the low level, 36% (18) for the medium level and 38% (19) for the high level. The biggest vestments found among the participants are: aged between 30 and 35 years (32%), female (88%), married (54%) and 48% have a postgraduate degree. In view of the results, it is observed that it is relevant to assess the incidence of Burnout Syndrome in nurses, as the development ofthe syndrome implies illness, reduced assistance and quality of care

Mapping, profile and training of immunization stakeholders, Benin, 2020

The Benin Immunization and Logistic Directorate commissioned this study to provide evidence-based data to improve the performance of the Expanded Programme on Immunization. The objectives were to identify immunization stakeholders, describe their profile, their geographical distribution and determine their training needs. In December 2020, we conducted a census of Benin's immunization stakeholders via their administrative files and telephone interviews. The data were collected in each departmental directorate and health zone by focal points using an Excel® grid. The authorizations of the ethics and personal data protection committees were obtained. We identified 3, 893 immunization workers, 39 years old on average, 66% of whom were women, 53% were health care assistants, 77% were vaccinators, and 56% were government contract workers. About 96% of them worked in peripheral centers. Approximately 56% were untrained and 14% had been untrained for more than 5 years. More than half of the actors were not trained for their function. The proportion of actors needing training was estimated at 70%. The training needs were at least 72% in the departmental hospitals, zone hospitals and health centers. 98% of actors reported a need for training, including immunization (74%), vaccine management (69%), cold chain (61%), monitoring (61%), and maintenance (47%). The predominance of nurses' aides and women and the low proportion of trained personnel among immunization workers were also observed in other sub-Saharan African countries. Benin's Immunization and Logistics Directorate should mobilize sufficient resources to strengthen the technical capacities of the majority of immunization stakeholders.

Differentiation of forms of protection of the right to medical assistance

The article aims to investigate the issue of the mechanism of protection of civil rights and the differentiation of procedural forms of protection of the right to medical assistance.
 The article examines the existing doctrinal approaches to the definition of the concept of "protection of civil rights", "means", "forms", "methods of protection of civil rights" arising in the field of providing medical assistance and health care.
 The work states that the methods of protection of rights are actions provided for by law, which are directly aimed at the protection of rights. They are final acts of protection in the form of material and legal actions or jurisdictional actions, which are aimed at eliminating obstacles in the way of subjects exercising their rights (interests) or at stopping the offense, restoring the situation that existed before the offense. Instead, the form of protection characterizes the order of protection and constitutes a set of internally agreed measures for the protection of subjective rights and protected interests that take place within the limits of one legal regime.
 Emphasis is placed on the fact that in the field of health care, first of all, the patient has the right to independently determine, by means of which form to protect his rights, which, in his opinion, have been violated during the provision of medical care. It can be the application of various pre-trial procedures, administrative appeal or appeal to the court.
 The article analyzes the implementation of judicial, pre-judicial and administrative forms of protection of a person's medical right in the field of health care.
 It was concluded that the non-jurisdictional form of protection of the patient's rights is a form of protection, in the implementation of which the patient can independently choose self-defense measures that are not prohibited by law and correspond to the nature of the actions that violated his right, as well as the consequences caused by the offense.

Socioeconomic status of the elderly MS population compared to the general population: a nationwide Danish matched cross-sectional study.

Multiple sclerosis (MS) leads to physical and cognitive disability, which in turn impacts the socioeconomic status of the individual. The altered socioeconomic trajectory combined with the critical role of aging in MS progression could potentially lead to pronounced differences between MS patients and the general population. Few nations have the ability to connect long-term clinical and socioeconomic data at the individual level, and Denmark's robust population-based registries offer unique insights. This study aimed to examine the socioeconomic aspects of elderly Danish MS patients in comparison to matched controls from the general population. A nationwide population-based study in Denmark was conducted, comprising all living MS patients aged 50 years or older as of 1 January 2021. Patients were matched 1:10 based on sex, age, ethnicity, and residence with a 25% sample of the total Danish population. Demographic and clinical information was sourced from the Danish Multiple Sclerosis Registry, while socioeconomic data were derived from national population-based registries containing details on education, employment, social services, and household characteristics. Univariate comparisons between MS patients and matched controls were then carried out. The study included 8,215 MS patients and 82,150 matched individuals, with a mean age of 63.4 years (SD: 8.9) and a 2:1 female-to-male ratio. For those aged 50-64 years, MS patients demonstrated lower educational attainment (high education: 28.3 vs. 34.4%, P < 0.001) and fewer received income from employment (46.0 vs. 78.9%, P < 0.001), and working individuals had a lower annual income (48,500 vs. 53,500€, P < 0.001) in comparison to the controls. Additionally, MS patients within this age group were more likely to receive publicly funded practical assistance (14.3 vs. 1.6%, P < 0.001) and personal care (10.5 vs. 0.8%, P < 0.001). Across the entire population, MS patients were more likely to live alone (38.7 vs. 33.8%, P < 0.001) and less likely to have one or more children (84.2 vs. 87.0%, P < 0.001). MS presents significant socioeconomic challenges among the elderly population, such as unemployment, reduced income, and increased dependence on social care. These findings underscore the pervasive impact of MS on an individual's life course, extending beyond the clinical symptoms of cognitive and physical impairment.

Social determinants of outcomes in nonoperatively treated proximal humerus fractures

Proximal humerus fractures (PHFs) are common fractures especially in the elderly, with most fractures being managed nonoperatively. Traditional biomedical factors such as radiological alignment have not been able to meaningfully predict comfort and capability after PHFs. Conversely, recent literature has increasingly recognized the role of psychological factors in determining comfort and capability after PHFs. Nonetheless, less is known about the impact of social factors. Additional study of these potentially modifiable social factors as targets for enhancing recovery from injury is merited. Among people recovering from a nonoperatively- treated proximal humerus fracture (PHF) we studied the social factors associated with patient-reported outcomes at 6 months and 1 year. One hundred seventy-one patients who received nonoperative management of a PHF completed baseline measures of sociodemographic characteristics (age, gender, race, employment status, household income, educational level, presence of domestic workers, housing type, and smoking status). Six and 12 months after fracture, participants completed the Oxford Shoulder Score (OSS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and EuroQol-5-Dimensions (EQ5D) measures of comfort and capability. The relationship between capability and social factors was assessed using linear regression modelling, accounting for potential confounding from age, fracture severity assessed using Neer classification, premorbid comorbidities measured by Charlson Comorbidity Index, and premorbid functional status measured by Parker Mobility Index and Barthel Index. Lower capability (higher QuickDASH scores) 6 months and 1 year after fracture were associated with being unemployed (coef:-5.02 [95% CI:-9.96 to-0.07]; P=.047) and having domestic workers at home (coef: 8.63 [95% CI: 1.39 to 15.86]; P=.020), but not with Neer classification. Both greater shoulder discomfort and magnitude of incapability (lower OSS scores) and worse general quality of life (lower EQ5D scores) were associated with having domestic workers (coef:-4.07 [95% CI:-6.62 to-1.53]; P=.002 and coef:-0.18 [95% CI:-0.29 to-0.07]; P=.001 respectively) or living in an assisted care facility (coef:-14.82 [95% CI:-22.24 to-7.39]; P<.001 and coef:-0.59 [95% CI:-0.90 to-0.29] P<.001). The finding that people recovering from PHF experience less incapability in proportion to their social independence (employment, absence of a caregiver such as domestic workers at home and living outside care facilities) emphasizes the important associations of social factors to musculoskeletal health, and the utility of accounting for social factors in the development and assessment of care strategies.

Socioeconomic and demographic disparities in rectal cancer treatment.

e15512 Background: Early treatment (tx) improves survival in rectal cancer (ca). We explored whether socioeconomic and demographic attributes are associated with time to tx initiation for rectal ca patients (pts) in New York's largest and most diverse healthcare system. Methods: 283 rectal ca pts were identified from three multidisciplinary tumor boards from 2019-2022. Time to tx was calculated as time from biopsy to first tx (surgery, chemotherapy, or radiation). Social work assistance was defined as an intervention by a social worker for home care, housing, or transportation assistance. Reasons for tx delay were assessed from physician and social work notes. Results: Median time to tx for all pts was 41 days. Time to tx was longer for Black/African American (BAA) (56.5 days; p &lt; 0.001) and Medicare only (46.5 days; p = 0.005) pts. No differences were seen in time to tx for all pts when stratified by first tx modality (surgery, chemotherapy, or radiation). In a univariable linear regression, BAA pts (vs Asian or White; p &lt; 0.001), Medicare only pts (vs Medicaid, Medicare with Supplemental, or Commercial Insurance; p = 0.001), and pts requesting social work assistance (p = 0.001) predicted longer time to tx. Employed pts (vs unemployed or retired; p = 0.034) predicted shorter time to tx. In a multivariable model, BAA (p = 0.013), Medicare (p = 0.022), and social work assistance (p = 0.029) predicted longer time to tx. The most common reasons identified for tx delay in BAA and Medicare pts were hospitalization during diagnosis (9%), evaluation of metastatic disease (9%), and tx hesitancy (7%). The odds ratio of being hospitalized during initial workup was 2.8 times higher for BAA than Asian or White pts (p = 0.007). Conclusions: Analysis of time to tx in rectal ca showed a notable delay for BAA pts, Medicare only pts, and pts requesting social work assistance. These findings may empower further studies to assess which factors are causal and to implement interventions that promote equity in timely tx for rectal ca pts. Reasons for tx delay were also not well documented and should be further elucidated. [Table: see text]

Assessing mail-in cryopreservation for fertility preservation.

1525 Background: Over 90% of oncologists agree that sperm banking should be offered to all men at risk of subfertility associated with cancer treatment, but fewer than 50% bring up the topic. Barriers cited include lack of time for the discussion, perceived high cost, and lack of convenient facilities. The advent of mail-in semen analysis (SA) testing and cryopreservation may improve access to this service via lower patient cost, decreased required oncologist logistical support, and home rather than local lab collection. That said, average sperm recovery rate after sample thaw is ~50% with immediate banking, and sperm recovery rate after delayed cryopreservation with a mail-in approach remains unknown. Methods: This is a prospective preliminary study assessing freeze-thaw total motile count at 3 time points of cryopreservation: upon receipt of sample, at 24 hours, and at 48 hours post collection. We collected 39 fresh semen samples from 13 healthy adult volunteers. Samples were diluted with 5mL of Fellow Health preservation solution and analyzed (World Health Organization guidelines V5). Samples were divided into 3 aliquots: Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 and aliquot #3, T48 were left at room temperature for 24 and 48 hrs respectively, analyzed, and then frozen. Aliquots were then thawed on a heat block at 37C for 10 minutes and analyzed. Results: Baseline SA values were: volume 3.3ml +/- 1.3, concentration 138.3 +/-57.4 x 106, motility 49% +/-6%; Total Motile Count (TMC) 213 +/- 110 million. TMC was the primary endpoint as measured by baseline semen volume, concentration, and motility at 3 time points (T0, T24, T48). The average loss from freeze/thaw in TMC at T0 was 45%, at T24 was 55% relative to T24 pre-freeze, and at T48 was 59% relative to T48 pre-freeze (p = 0.013). On average, samples with starting TMC between 50-100 million had enough motile sperm for six intrauterine insemination (IUI) cycles when frozen and thawed at T0, two at T24, and two at T48. Samples with starting TMC between 100-200 million had enough motile sperm for 16 IUI cycles when frozen and thawed at T0, eight at T24, and four at T48. Samples with starting TMC &gt; 200 million had enough motile sperm for 42 IUI cycles when frozen and thawed at T0, 21 at T24, and nine at T48. All samples had ample viable cells ( &gt; 50,000) at all three time points for in vitro fertilization (IVF). Conclusions: Mail-in cryopreservation using our improved methodology may increase access to this service for oncological patients while still facilitating reasonable assisted reproductive technology care relative to in-person cryopreservation.

EPH174 Trends in Postpartum Depression before and during the COVID-19 Pandemic and Correlates of Treatment Choices: A Population-Based Retrospective Cohort Study

COVID-19-related stressors – including social distancing, material hardship, increased intimate partner violence, and loss of childcare, among others – may result in a higher prevalence of depression among postpartum individuals. This study examines trends in postpartum depression in the US from 2018 to 2022, as well as correlates of treatment choices among women with postpartum depression. 1,108,874 women aged 14-64 in the Komodo Healthcare Map with 1+ live birth between April 2018 and December 2021 and had continuous enrollment 2+ years before and 4+ months after the delivery date were included. Prevalence of depression during postpartum (within 3 months after delivery) was calculated before (April 2018–March 2020) and during (April 2020–March 2022) COVID-19. Multinomial logistic regression was used to investigate correlates of treatment choices (no treatment, medication-only, psychotherapy-only, or both). The prevalence of postpartum depression increased from 9.7% pre-pandemic to 12.0% during the pandemic (p < 0.001). Among 119,788 women with postpartum depression in 2018-2022, 47.0% received no treatment, 35.0% received medication-only, 10.0% received psychotherapy-only, and 7.4% received both within one month following their first depression diagnosis. Factors associated with an increase in the odds of receiving medication-psychotherapy treatment (vs. no treatment) included older ages; commercial insurance coverage; lower social vulnerability index; history of anxiety or mood disorder during and before pregnancy; and being diagnosed by a nurse practitioner, physician assistant, or behavioral care practitioner (vs. physician). Similar patterns were observed for medication-only and psychotherapy-only treatments. In this large, nationally representative sample of US insured population, the prevalence of postpartum depression increased significantly by 2.3 percentage-points during the pandemic (or a relative increase of 23.7%). Nonetheless, almost half of women with postpartum depression received no treatment, and only 7.5% received both medication and psychotherapy. The study highlighted potential socioeconomic and provider variation in postpartum depression treatment.

Patient characteristics associated with psychosocial distress about end-of-life.

12031 Background: A cancer diagnosis and subsequent treatment can cause significant psychosocial distress, including fear about the end of life (EoL). Although distress is common, it often goes unrecognized due to the challenge of routine psychosocial distress screening. This study sought to determine patient characteristics associated with EoL-related distress. Methods: A validated psychosocial distress screening tool (SupportScreen) was administered to patients prior to treatment at an NCI-designated cancer center between 2009-2017. Fear about EoL was measured on a 5-point Likert scale with scores of ≥3 indicating “high” distress. Multivariable logistic regression was used to test the association between fear of Eol and patients’ characteristics (age, sex, education, household income, survey language, race/ethnicity, and cancer diagnoses). Pairwise comparisons were run for cancer types and p-values were adjusted. Results: A total of 4,198 patients with cancer were included. Of these, 21.5% reported high distress from fear about EoL. Most patients were women (61%) and non-Latino white (60%). The average age was 59.9 years (SD = 13.9). About 29% of the participants had household income &lt; $40,000. The most common cancers in this sample were breast (22%), hematological (15%), gastrointestinal (14%) and gynecological (13%). Adjusted analyses showed that being a woman (OR = 1.30, p &lt; 0.042), taking the survey in Spanish (OR = 1.71, p = 0.020) and having a household income &lt; $40,000 (OR = 1.80, p &lt; 0.001) were all associated with high distress for EoL. Among cancer types, lung cancer (versus breast, digestive, gynecological, hematological, and prostate cancers) was significantly linked to high distress (p-values &lt; 0.05). Conversely, older age (OR = 0.99, p = 0.009) was associated with low distress. Conclusions: In this study, we identified patient clinical and demographic characteristics associated with high levels of distress due to fear of EoL. Patients who have lower household income, limited English proficiency, are younger, and female, as well as patients with lung cancer, may benefit from targeted screening for EoL distress, to facilitate early identification and tailored supportive care assistance.