pan-Canadian Study Research Articles

68 Provincial Variations in Radiotherapy Utilization as a Measure of Access: A Pan-Canadian Study

68 Provincial Variations in Radiotherapy Utilization as a Measure of Access: A Pan-Canadian Study

Barriers to fertility preservation (FP) in a prospective pan-Canadian study of young women with breast cancer (YWBC).

136 Background: Despite ASCO recommendations that oncologists routinely offer FP to young cancer patients prior to treatment, studies show that only a minority of YWBC are given this option. We sought to determine whether an intervention, including educational materials and regular reminders to breast surgeons, would improve FP referral. The current report examines the rates of FP discussion, referral, uptake and reasons for declining, according to participants’ self-reported pre-diagnosis fertility plans. Methods: Consecutive women ≤ age 40 newly diagnosed with breast cancer at 30 Canadian sites were offered enrolment in a national study of YWBC. At 3 months each participant was surveyed regarding her pre-diagnosis (dx) fertility plans and post-dx oncofertility management. Results: Of the 712 recruits (09/15 to 08/18) with invasive disease (mean age 36), 46%, 15% and 29% had 0, 1 or 2 children respectively and 77% were in a stable relationship. Among the 480 women who completed the fertility survey, 392 (82%) indicated they had a pre-treatment fertility discussion initiated by a health care provider (HCP) - in 232 cases (48%) the surgeon/nurse and in 130 cases (27%) the medical oncologist/ nurse. Only 14 (16%) of the 88 women not approached by a HCP initiated such a discussion. Rates of FP discussion, referral and uptake are shown below. Among the 38 women who definitely wanted (more) children prior to dx and were offered FP but declined the consult or procedure, the commonest reasons were cost (n = 9) and fear that treatment delay (n = 8) or FP (n = 4) could cause recurrence. Conclusions: Post-intervention FP discussion rates were higher than previously reported. Yet 26% of patients who had definitely/probably not completed their family were not referred for a FP consult. Cost remains a significant FP barrier. Studies are needed to confirm the long-term safety of FP for ER+ patients. [Table: see text]

The Role of School Administrator in Providing Early Career Teachers’ Support: A Pan-Canadian Perspective

This article is based on an extensive mixed-methods pan-Canadian study that examined the differential impact of teacher induction and mentorship programs on the retention of early career teachers (ECTs). It discusses the findings from the analysis of publicly available pan-Canadian documents detailing the mandated roles, duties, and responsibilities of school administrators in teacher induction and mentorship. It then describes the results of the Teacher Induction Survey (N = 1,343) and the telephone interviews (N = 36) that elicited the perceptions of Canadian early career teachers regarding the school administrator’s role and engagement in effective teacher induction and mentoring programs.

Trends and Determinants of Self-Reported Aspirin Use Among Patients with Diabetes Stratified by the Presence of Cardiovascular Diseases—A Repeated Pan-Canadian Cross-Sectional Study

Trends and Determinants of Self-Reported Aspirin Use Among Patients with Diabetes Stratified by the Presence of Cardiovascular Diseases—A Repeated Pan-Canadian Cross-Sectional Study

Understanding the Experiences of Cancer Patients as They Transition From Treatment to Primary and Community Care: A Pan-Canadian Study of Over 13,000 Cancer Survivors

Background: Being diagnosed with cancer can be overwhelming, with many physical and emotional challenges. As needs of survivors shift from disease management to recovery, the adjustment is often not seamless. Ideally, a health care system is integrated and responsive to the needs of survivors, however, when cancer treatment is complete, they often face lingering concerns. Limited patient-reported data were available in Canada on experiences and barriers survivors face posttreatment. Aim: The Experiences of Cancer Patients in Transition study is the first national survey gathering data from cancer survivors in Canada as they transition from cancer care to the broader health care system. Methods: A survey was developed in consultation with patients/survivors, health care providers and researchers to address experiences related to physical, emotional, informational and practical needs. Ethics approvals were obtained and 10 provinces participated. Cancer survivors expected to have completed treatment within 1-3 years were identified from provincial cancer registries. Included were those aged 30+ at diagnosis of nonmetastatic breast, colorectal, prostate, melanoma or hematologic cancer; or aged 15-29 at diagnosis of any nonmetastatic cancer or metastatic testicular cancer. Despite the intention of the sampling, the final sample included some survivors diagnosed with a site other than the target sites, and some whose time since treatment was outside 1-3 years. All respondents are included in this analysis. Results are not weighted to represent the true distribution of cancer survivors. Results: From a total survey population of 40,790 Canadian cancer survivors, 33% completed the survey. The respondents were 48% male, 51% female; 2.5% were under 30 years old, 60% were 65+. 68% of respondents reported challenging periods posttreatment, with 48% of these saying that the first 6 months to 1 year were most challenging. Cancer survivors continued to live with side-effects: 87% reported physical challenges; 78% reported emotional challenges; 45% reported practical challenges. The most prevalent concerns were fatigue (68%), anxiety about cancer returning (68%) and returning to work/school (23%). Less than half of those with emotional or practical concerns received useful information (42% and 46%, respectively). 42% of respondents could not get help to address their most difficult concern. Of those who could get help, 10.7% waited a year or more. Conclusion: The results provide insight into the nature of challenges cancer survivors face, as well as needed supports and barriers faced in accessing them. There is a clear need for health systems to ensure a seamless patient experience throughout the cancer journey, for instance, through development and adoption of resources to help health care providers and their patients identify and address challenges from diagnosis through to survivorship.

Building a Pan-Canadian Real World Health Data Network

BackgroundIn December 2017 the Canadian Institutes of Health Research (CIHR) issued a request for proposals to develop a pan-Canadian health data platform. This platform will enable cross-jurisdictional research by facilitating the use of rich provincial and national data and ensure engagement with patients and specific populations including Indigenous partners. Academics and policy makers from across Canada operating under the banner of the Pan-Canadian Real-World Health Data Network (PRHDN) have joined forces to address this call.
 ObjectivesCreate national infrastructure that is built once then made available for research, benchmarking, performance monitoring, multi-jurisdictional evaluations and inter-jurisdictional comparisons to address pressing health and social policy problems in Canada.
 MethodsOur approach will address several issues including creating significant efficiencies in data access, streamlining cross provincial/ territorial ethics and access approvals, establishing standards for data and methods harmonization and providing innovative and privacy-conscious solutions to data access and use. The presentation will focus on the plan to create harmonized common data, algorithms and analytic protocols, and link administrative data to electronic medical records and clinical trials to create an integrated and documented infrastructure for pan-Canadian studies. Comparisons to PopMedNet and the Sentinel Initiative in the US will be made.
 ConclusionProvincial centres across Canada hold rich sources of health and social data that are linkable at the person-level. With the exception of standardized data managed by the Canadian Institute for Health Information (CIHI), these data are often not comparable from one province to another, thereby limiting use to single-province studies. There is growing interest in Canada in creating an environment that would enable cross-jurisdictional data sharing and analysis’ and in sharing experiences to make effective use of linkable administrative data.

OA 15.01 Lung Cancer Screening: Participant Selection by Risk Model – the Pan-Canadian Study

OA 15.01 Lung Cancer Screening: Participant Selection by Risk Model – the Pan-Canadian Study

Canadian Service Providers’ Perceptions of Barriers and Support Gaps in Housing and Mental Health

People experiencing mental illness and homelessness face numerous barriers to becoming housed. Service providers who work with this population also encounter challenges to meeting service users’ needs, yet their perspectives have been only minimally studied. Using survey data from a pan-Canadian study, this article explores the barriers and facilitators to fostering lasting change in housing and mental health according to 96 housing providers and 186 community-based mental health service providers. Findings show that the perspectives of mental health service providers are largely consistent with those of housing providers, and identify a range of support gaps and barriers.

An introduction and overview of research and knowledge translation practices in a pan-Canadian art-based health research study

Abstract This article provides a brief overview of the emergence of art-based health research and describes a pan-Canadian study exploring the experience of researchers, artists and trainees engaged in this work. Research participants are described and specific research projects explicating the array of art-based knowledge creation and translation practices are outlined as exemplars of this work. In order to highlight the diversity of art-based research, four unique projects are presented, which exemplify the art genres represented in the study: performative, literary, visual and multi-media.

The Nascent Pan-Canadian Real-world Health Data Network (PRHDN)

ABSTRACT
 ObjectiveCanada’s large single payer health systems have created provincial centres with rich, population-wide health and social data holdings that are linkable at the person level. Complementary federal data include a subset of standardized and enriched administrative healthcare data at the Canadian Institute for Health Information, Statistics Canada’s extensive array of survey- and census-based social and geography-based information, and large national datasets that are being created through pan-Canadian initiatives. Unfortunately, these data assets are rarely combined in multi-province or pan-Canadian studies, often because data are not directly comparable from one province to another, or cannot be shared due to legislative or other barriers. There is now growing interest in enabling multi-province studies — even when data are not directly comparable — and in sharing experiences to make more effective use of linked or linkable administrative data across Canada.
 ApproachNine provincial and national organizations have created a detailed Implementation Plan for the new PRHDN distributed data network. Without requiring that record-level data leave provincial boundaries, the PRHDN will create shared core research data infrastructure: (i) validated algorithms that implement case definitions applicable across provinces, (ii) harmonized common data and (iii) common analytic protocols. The PRHDN will also establish complementary infrastructure including dedicated personnel to assist researchers and decision makers, joined-up training and capacity building sessions, opportunities to share learning and experience related to linking new datasets such as electronic medical records and omic datasets, and forums for knowledge translation and exchange with decision makers.
 ResultsThe PRHDN is already bringing together expertise from across Canada as researchers, decision makers and data custodians begin to identify opportunities for enhanced use of health data in Canadian research, policy making and practice. A simple PRHDN website has been created (https://www.prhdn.ca/) and more than 200 researchers and policy/decision makers have become members of the PRHDN consortium. Surveys of consortium members are identifying priorities for the first algorithm validation work (to-date the top four priorities are mental health, cardiovascular disease, diabetes and respiratory disease) and the PRHDN Leads Team is functioning as a decision-making body, e.g., in discussions with Statistics Canada.
 ConclusionsWorking together, provincial and national organizations across Canada have identified concrete steps that can be taken to enable multi-province and pan-Canadian studies based on administrative data within one year of the start of funding. The PRHDN Leads Team is currently discussing the PRHDN vision and Implementation Plan with potential funders.

Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery: A Population-Based Review Using a National Administrative Database.

In this pan-Canadian study, we sought to elucidate the current state of surgical care for primary ovarian cancers and factors influencing selected short-term outcomes; these were in-hospital mortality (IHM), major complications (MCs), failure-to-rescue (FTR), and hospital length of stay (LOS). We created a population cohort using inpatient admission records from the Canadian Institute of Health Information data set (2004-2012). Multilevel logistic regression and flexible parametric survival analyses, adjusted for hospital clustering effect, were conducted to determine the effect of patient-specific factors (i.e.,age, comorbidities, and admission category); procedural complexity; and the surgical volume and specialty of each care provider on the outcomes of interest. A total of 16 089 women underwent surgeries for primary ovarian cancer across Canada. The crude rates of IHM, MC, and FTR were 0.89%, 5.7%, and 9.09%, respectively, with a median LOS of four days (interquartile range 3 to 6). The majority of surgical procedures were performed by surgeons and hospitals with annual surgical volumes of less than five such procedures. Hospitals with higher surgical volumes were associated with lower risk of IHM (OR 0.95, 95% CI 0.91 to 0.99) and FTR (OR 0.95, 95% CI 0.91 to 0.99) and a higher chance of earlier discharge (hazard ratio [HR] 1.03, 95% CI 1.00 to 1.06). Surgeons with higher surgical volumes were associated with lower odds of early discharge (HR 0.90, 95% CI 0.87 to 0.94) and a higher risk of MC (OR 1.12, 95% CI 1.02 to 1.23). Compared with gynaecologic oncologists, general surgeons had a significantly higher risk of IHM (OR 3.50, 95% CI 1.82 to 6.74) and MC (OR 2.13, 95% CI 1.36 to 3.33) and lower odds of early discharge (HR 0.43, 95% CI 0.40 to 0.47). Despite limitations in the administrative data set, valuable information was available for this pan-Canadian analysis. Our findings support centralization of surgical procedures for women with ovarian cancer in tertiary care centres with higher surgical volumes that are staffed by in-house multidisciplinary care teams and specialist surgeons.

Redeploying public librarians to the front-lines: prioritizing digital inclusion

Purpose This paper aims to draw attention to the quiet, if inadvertent, disappearance of the front-line public librarian, as libraries make difficult organizational choices in the struggle to survive the relentless pressures to cut costs on one side while supporting a market ethos of customer service on the other. Design/methodology/approach Informed by the preliminary findings of a pan-Canadian study of labour in large urban public libraries and a review of professional and academic literatures dealing with contemporary service trends, four models/proposals [(1) participative, (2) community-led, (3) managerial/leadership and (4) digital inclusion] are critically reviewed with respect to their positioning of the front-line professional librarian. Findings The paper concludes with an argument in favor of one of these proposals because it supports the relevance of public librarians in service to their communities while remaining true to the democratic aspirations of this vital public service within our increasingly complex information societies. Research limitations/implications The implication of this work is that by drawing our attention to the contradictions inherent within contemporary and popular library initiatives, the disconnect between formal education and professional practice is highlighted, thus providing a foundation for new empirical research into the changing nature of waged work (professional and non-professional) in public libraries. Practical implications Failure to situate the professional public librarian strategically and unambiguously within the rapidly evolving roles of the public library has implications for LIS educators, employers and, as significantly, current and future students. Social implications Despite the high rates of connectivity among Western nations and the increasing sophistication of their populations, the digital divide persists among a growing urban and rural underclass. Building, maintaining and promoting a strong and accessible municipal information infrastructure, one could argue, is what public librarianship is all about. Originality/value This paper’s identification and critical review of the four dominant service models proposed for the present public library represents the first time that these literatures have been assembled together and critically interrogated for their implications for the work of public librarians. Given the importance of the question “what is the future role of the public library”, a critical analysis of the key contenders is a necessary exercise, as is shifting the subject of the conversation away from the customer and onto the professional public librarian.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings.

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors

Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified.

Bridging the gap: The design of a survivorship curriculum for interspecialty collaboration.

13 Background: Interspecialty learning between trainees from different postgraduate training programs is unusual in Canada. Primary care providers (PCPs) have an increasing role in the provision of survivorship care in collaboration with cancer specialists (ONC), but coordination of care is often lacking and avenues for joint learning and interaction among these physicians are limited during residency. We are piloting a learning suite (LS) for PCP and ONC trainees in MB, ON & BC as part of a pan-Canadian study on integration of care between primary and cancer specialty care. Methods: Using Kern’s Six-Step Approach to Curriculum Design, a national team of experts conducted surveys and focus groups with postgraduate program directors, cancer survivors, and trainees. We set learning objectives as informed by the needs assessment and used constructive alignment to build the curriculum in a blended learning format: online, workshop and clinical. We are assessing inter-disciplinary learning outcomes comparing pre and post results on a modified Readiness for Interprofessional Learning Scale (M-RIPLS) in three pilot sites in 2015 with about 40 family medicine and oncology trainees. Results: Learning materials have been developed for a mixed audience of trainees. The interactive, one hour online session addresses cancer epidemiology, the domains of survivorship care, and specific issues in follow-up care for three cancer types, as well as province-specific survivorship initiatives. This is followed by a two hour, case-based learning workshop that focuses on collaboration and shared care. A clinical experience in cancer follow-up clinics concludes the LS. In PCP training sites without a nearby cancer centre, trainees are able to review videos of actual transitional appointments and follow-up clinics and of the cancer centre/oncologist perspective on shared care. Pilots are ongoing in 2015 with national rollout in 2016. Conclusions: We expect that learning together in residency will impact on attitudes towards interspecialty collaboration in the care of cancer survivors. This interspecialty, blended learning curriculum will enhance the place of survivorship training in the postgraduate education of Canadian physicians.

Integrating primary care and cancer care in survivorship: A collaborative approach.

103 Background: Primary care providers (PCPs) have an important role in the provision of survivorship care. While there is evidence to support the feasibility and safety of PCP-led survivorship care, there are gaps in knowledge about how to best integrate providers to support transitions, enhance quality of care, increase system efficiencies, and improve patient and provider satisfaction. Methods: A pan-Canadian study comprised of three projects has been initiated to address three key aspects of care integration, based on a previously described system performance framework. Functional integration will be studied through the evaluation of electronic survivorship care plans using a prospective cohort of breast and colorectal cancer patients with pre and post measures of knowledge, care coordination, and satisfaction. Vertical integration will be evaluated through a series of descriptive case studies to document structures and processes that are currently in place to support PCP re-referral to regional cancer centres. Clinical integration will be studied through the development and evaluation of an interspecialty survivorship training curriculum for oncology and family medicine trainees. Results: Functional integration: Development of an electronic platform for care plan outputs is complete. Two sites in Ontario (ON) and one in British Columbia (BC) have been selected to study the impact on 200 patients and their providers. Vertical integration: Using a study-specific interview guide, 48 semi-structured key informant interviews have been successfully conducted in ON; 15 interviews are planned for Manitoba (MB) and 15 for BC. Clinical Integration: a National Advisory Committee was established and needs assessments were performed with postgraduate program directors, cancer survivors, and trainees using online surveys and focus groups. A blended learning curriculum is being piloted in MB, ON, and BC in 2015. Conclusions: Integrating primary care and cancer care in survivorship requires a collaborative approach that begins in residency, supports PCPs with clear mechanisms for re-entry, and optimizes communication. This study will inform approaches to enhancing provider integration and survivorship care.

Canadian community pharmacists' use of digital health technologies in practice.

In 2010, a pan-Canadian study on the current state and benefits of provincial drug information systems (DIS) found that substantial benefits were being realized and that pharmacists perceived DIS to be a valuable tool in the evolving models of pharmacy practice. To understand changes in digital health and the impact on practice since that time, a survey of community pharmacists in Canada was conducted. In 2014, Canada Health Infoway (Infoway) and the Canadian Pharmacists Association (CPhA) invited community pharmacists to participate in a Web-based survey to understand their use and perceived benefits of digital health in practice. The survey was open from April 15 to May 12, 2014. Of the 447 survey responses, almost all used some form of digital health in practice. Those with access to DIS and provincial laboratory information systems (LIS) reported increased productivity and better quality of care. Those without access to these systems would overwhelmingly like access. There have been significant advances in digital health and community pharmacy practice over the past several years. In addition to digital health benefits in the areas of productivity and quality of care, pharmacists are also experiencing substantial benefits in areas related to recently expanded scope of practice activities such as ordering lab tests. Community pharmacists frequently use digital health in practice and recognize the benefits of these technologies. Digital health is, and will continue to be, a key enabler for practice transformation and improved quality of care. Can Pharm J (Ott) 2016;149:xx-xx.

Mobile Device Use in Pharmacy: A Multi-Institutional Study

<span>Although there are studies that explore the use of mobile devices by physicians and pharmacists, there has not been a study to date that examines the prevalence and usage patterns of mobile devices amongst pharmacy students and faculty. This is the first pan-Canadian study that examines the prevalence and patterns of use of mobile devices by pharmacy faculty and students at Anglophone and Francophone universities. Unlike previous studies, this study also included interviews with participants to collect richer data than can be gathered with an online survey alone.</span>

Research and evidence in education decision-making: A comparison of results from two pan-Canadian studies

In this paper we compare the use of research and other evidence in the policy formation practices of two groups of education policy elites, situated in different contexts – provincial education ministries and school districts. Data are derived from two pan-Canadian studies: Galway (2006) and Sheppard, Galway, Brown & Wiens (2013). The findings show that policy decisions at the ministry level are informed primarily by political and pragmatic factors, personal and professional beliefs and staff advice. The role of external research is shown to be relatively marginal and confined to quantitative studies and performance assessments. Decision makers at the school district level are less attendant to political and pragmatic influences relying more on personal beliefs, values and experiential factors supplemented by the advice of professional staff and in-house research/indicators. Results from both studies demonstrate limited reliance on external data and university-based research – the latter ranking 15th of 20 influencing factors. Consistent with Beck’s (1994; 1997) risk theory, we theorize that education policy making in both contexts is influenced by both macro- and micro-level factors, where choice of policy evidence is mediated by personal considerations and political risk factors. This suggests a weak policy development paradigm that is, to a large extent, resistant to independent research-informed evidence.

The planning of a national breastfeeding educational intervention for medical residents

Background: Breastfeeding is the ideal form of nutrition for newborns, yet our recent pan-Canadian study showed that the knowledge, attitudes, and beliefs of primary care pediatricians and family physicians are suboptimal with regard to breastfeeding.Objective: We aim to develop, implement, and evaluate a national breastfeeding educational intervention at the postgraduate residency level.Methods: Our initial development process is informed by Kern’s approach to curriculum development. To date, we have completed breastfeeding education needs assessment surveys of both practicing physicians and medical residents. We have also developed learning outcomes as well as possible strategies for implementing and evaluating this future educational intervention.Results: The results of our needs assessment surveys provided a rationale to develop a breastfeeding educational intervention for medical residents. Through stakeholder consultations, we have developed five initial learning outcomes for a national breastfeeding educational intervention. We have also identified promising strategies for implementing and evaluating the intervention.Conclusions: This systematic process has provided an opportunity to create a national breastfeeding educational intervention for medical residents. It has fostered collaboration between experts and knowledge users, with the goal of impacting breastfeeding rates and duration of women, which will lead to improved maternal and child outcomes.