8th Annual McGill Familiy Medicine Research Symposium (FMGSS) | June 7th, 2023
Family Medicine Graduate Student Society at McGill University
Published online: June 7th, 2023Modeling Colonoscopy Wait times for Colorectal Cancer Screening in Quebec
2Department of Quantitative Life Sciences, McGill University, Montreal, QC, Canada *Equal Contribution
Corresponding Author: Chen-Yang Su, email: chen-yang.su@mail.mcgill.ca
Abstract
Background Due to the COVID-19 pandemic, Quebec has large and increasing waitlists for colonoscopies, which can lead to substantial morbidity and mortality due to delayed detection and treatment of colorectal cancer. There is a need for prioritizing referral for colonoscopy for heterogeneous patient populations due to staffing shortages related to the pandemic. Objectives Our main objective is to inform strategies to address growing colonoscopy wait lists in Quebec by using retrospective analysis to understand the current state and simulation modeling to project the operational, clinical, and health economic impact of various strategies. Methods In this study we used a decision-analytic modeling approach to evaluate policies to address colonoscopy wait times in Québec. We used a microsimulation model parameterized by a time series analysis to simulate the general population using summary measures and estimates from literature for population characteristics. We validated our model by comparing our model estimates to Montreal data from 2018 to 2022 including colonoscopy wait times, rate of clinically significant findings, and rate of (pre)cancerous findings by stage. Anticipated Results We anticipate that we will be able to provide data-driven insights into factors driving Québec’s colonoscopy wait lists as well as timely insights to inform the effective, efficient, and equitable use of finite colonoscopy capacity in the province to improve the health of Quebecers. Conclusion/Implications Our approach provides an understanding of how colonoscopy delays impact different patient populations defined by clinical and demographic characteristics and provides an estimate of the impact of potential strategies to address colonoscopy wait times on screening, surveillance, and symptomatic patients in terms of their operational, clinical, and health economic outcomes.
Understanding how issues of women’s and girls’ health are prioritized in the Sustainable Development Goals (SDGs) and what it means for health policy: a critical case analysis
2School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
Corresponding Author: Alua Kulenova, email: alua.kulenova@mail.mcgill.ca
Abstract
Background: Globally, women and girls are a vulnerable population with specific health needs resultant from complex underlying social, cultural, biological, and economic determinants of health. Policy is a means for ameliorating the unique challenges that women and girls face in achieving good health, but it is often a significant driver of health inequity. A prominent challenge facing health issues on a global scale is that there is no single government or agency that can solely intervene to promote health in women and girls. Thus, the Sustainable Development Goals (SDGs) are designed to guide nations adhering to the global agenda on gender and health equity. Given the power of the SDGs to shape policy, it is crucial to know which issues in women and girls’ health are prioritized and how associated problems and solutions are represented within the SDGs to understand the implications for women and girls’ health. While gender inequity is recognized as a pertinent issue across the SDGs, there is a lack of research to identify which issues of women and girls’ health inequity are prioritized within the SDGs, the processes that underlie priority-setting, and the implications of current priority frameworks. Objectives: a) Identify which health issues are associated with women and girls and which issues are given priority b) Understand the criteria and rationale used to justify and support this prioritization c) Understand how the causes of health disparities associated with women and girls are presented in the SDGs d) Identify how current priorities and framing in the SDGs may impact health policy Methods: This research will analyze SDG documents using qualitative frameworks and draw from key informant interviews with relevant stakeholders. Anticipated results: 1.) an academic paper presenting the results from the document analysis; 2) another academic paper that presents the findings from the key informant interviews; 3) research findings that will be returned to participants in the form of a 2-page graphic brief that presents the results using infographics, figures, and tables Conclusion/Implications: This research can inform SDG implementation efforts by encouraging critical analysis of how problems of health inequity are represented in policy and establish a base for further research related to gender-informed health policy by noting which issues have been included or excluded and with what implications for addressing health disparities among women and girls.
Assessing challenges for implementing social prescription in primary care to improve the health and wellbeing of older adults in Montréal
2Department of Marketing, Université Laval, Québec City, QC, Canada
3Department of Family Medicine, McGill University, Montreal, QC, Canada
Corresponding Author: Katrina Streef, email: katrina.streef@mail.mcgill.ca
Abstract
Background: Social prescribing is a model of care that bridges the gap between health and social services by having healthcare providers refer patients with social needs to community-based, non-clinical services in their community. Social prescribing is a promising approach that can address older adults' social needs to improve their health and wellbeing. Objectives: This study explores implementation challenges in delivering community-based services that address social determinants of health for older adults. The aim is to identify opportunities and strategies to improve access to and delivery of needed community services for older adults and their connection with the primary care system. Methods: Semi-structured interviews will be used to capture the experiences and perceptions of service providers and older adult clients, aged 65+, when delivering or using community programs that address social determinants. Interviews will be conducted with service providers working in Côte-Des-Neiges—Notre-Dame-De-Grâce borough of Montréal and older adult clients using services in this neighborhood. Following the interviews, a deliberative dialogue will bring service providers and older adult clients together to discuss opportunities and strategies to improve access to and delivery of needed community services. The collection of qualitative data and its analysis will be guided by the Consolidated Framework for Implementation Research (CFIR). The Framework Method will guide the thematic analysis of the interviews and deliberative dialogue. Anticipated Results: The results from the thematic analysis of interview data will inform the prompts used in the deliberative dialogue discussion. The deliberative dialogue will enable the interview findings to be considered for their relevance and impact from multiple perspectives. Implications: The results of this study will inform the design and implementation of a feasible social prescribing pathway for older adults in Montréal, QC, Canada.
Decisional Stakes and Patient-Provider Incongruency during Shared Decision Making: A Family Medicine Resident Perspective
Corresponding Author: Amrita Sandhu, email: amrita.sandhu@mail.mcgill.ca
Abstract
Background Training Canadian physicians in shared decision-making (SDM) occurs during postgraduate medical education. However, the extent to which medical residents are willing to engage in SDM is unclear. As the popularity of SDM continues to grow, residents will encounter situations where patient-provider incongruency exists regarding next steps to care. Little is known about how comfortable residents are providing care when patient perspectives misalign with their own during SDM. Objectives Study objects are to (i) assess how family medicine (FM) resident perceptions of situational stakes influences their comfort providing care when faced with patient incongruency and to (ii) describe what FM residents consider to be high versus low stakes situations when engaging patients in shared decisions. Methods A sequential explanatory mixed methods study was conducted with first year FM residents at McGill University who attended an academic-half day session about SDM. Quantitative: Residents were asked to complete a 7-item version of IncorpoRATE to measure willingness to engage in SDM. Qualitative: Using extreme case-sampling of IncorpoRATE responses, N=16 residents were interviewed about what they consider high versus low stakes situations for SDM and how this affected their comfort providing care in the context of patient-provider incongruency. Integration: the results of the qualitative and quantitative study components were compared and combined. Results Residents expressed higher comfort with incongruent patient choice when the stakes were perceived as low (7.59 [2.01]) versus high (4.38 [2.47]). Qualitative findings revealed variation in what types of decisions residents considered low and high stakes for SDM. PSA tests are one example of a shared decision where lack of consensus existed between situational stakes being high or low. Several factors that increased or decreased resident comfort with patient incongruency were also identified: patient health literacy, perceived consequences, involvement of proxy decision makers, administrative and legal concerns, and perceived therapeutic alliance. Conclusion and Implications Residents are less comfortable with incongruent patient preferences when they perceive the situation to be high stakes. However, what is considered high or low stakes varies widely across residents. This perception subsequently influences their comfort level engaging in SDM when patients harbor incongruent perspectives regarding a specific decision. My findings reveal the need to refine or remove Item 6 and Item 7 of the IncorpoRATE measure so that they better assess their intended construct. More work must be done to establish definitive parameters about the stakes of situations for SDM. Medical educators must also consider how individual risk perception affects comfort involving patients in medical decision-making, particularly when patient-provider incongruency arises.
How Men-who-Have-Sex-with-Men Living with HIV in Montreal, Quebec construct “Sexual Health”
2Department of Family Medicine, McGill University, Montreal, QC, Canada
3Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
4Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
5Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
Corresponding Author: Francesco Avallone, email: francesco.avallone@mail.mcgill.ca
Abstract
Background: Sexual health (SH) can be thought of as a state of biopsychosocial wellbeing related to sexuality, beyond the absence of disease/dysfunction. Men who have sex with men (MSM) living with HIV may benefit from SH promotion interventions. Exploring their views on SH is relevant to ensure their overall wellbeing. Objective: To explore defining features of SH for MSM with HIV. Methods: Twenty-one MSM were interviewed from 2017 to 2019 as part of CTNPT013, a study on the SH of mixed-status MSM couples (one HIV-positive, the other HIV-negative). It was conducted at the McGill University Health Centre and Clinic L’Actuel. Participants were asked in semi-structured interviews about what SH means to them and the factors that affect it. We performed a content analysis of interview transcripts from participants living with HIV (N = 10), coding them according to the 10 categories of Robinson’s (2002) model. Results: Mean age of the 10 participants was 35.5 (SD = 10.2; range: 20–53). Two were born in Canada and 8 in another country. All identified as gay/homosexual. Every dimension of Robinson’s model was mentioned, except for Spirituality. All indicated Intimacy/Relationships as a relevant aspect of SH, particularly in terms of agreements with their partner (e.g., nonmonogamy) and communication within the couple. Sexual Health Care/Safer Sex was also raised by all participants, relating SH to sexually transmitted infections, risk behaviours, and associated knowledge. Other relevant features included: Positive Sexuality (70%), such as pleasure/enjoyment during sex; Talking about Sex (50%), which mainly related to concerns about HIV disclosure; Body Image (40%), which pertained to being comfortable in one’s own body; Challenges to SH (40%), including substance abuse and transactional sex; and Sexual Functioning (30%), broached in relation to the detrimental effects of aging. Only 2 participants referred to Culture/Sexual Identity and Masturbation/Fantasy. Three SH dimensions beyond Robinson’s categorization were identified: Emotions (30%), Self-care (20%), and Aging (10%). Conclusion: Intimacy and relationships, safer sex, and positive framings of sexuality are key features of SH according to a small sample of MSM living with HIV. Perspectives on the key features of SH should be assessed on a larger sample of this population through further qualitative/quantitative work in order to inform interventions targeting their SH needs.
The diagnostic threshold for gestational diabetes: Should it be lowered to improve pregnancy outcomes?
2Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
3Division of Endocrinology and Metabolism, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
4Division of Endocrinology and Metabolism, Faculty of Medicine and Health Sciences, McGill University Health Centre, Montreal, QC, Canada
5Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
6Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
7Precision Analytics, Montreal, QC, Canada
8Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
Corresponding Author: Sanaz Azizi, email: sanaz.azizi@mail.mcgill.ca
Abstract
Background: Gestational diabetes mellitus (GDM) is one of the most frequent complications of pregnancy. Studies indicate that adequate maternal glycemic control improves outcomes for mother and offspring. However, there is no consensus regarding the best GDM diagnostic test or cut-points. Both approaches suggested by the Diabetes Canada 2018 guidelines for diagnosis of GDM include a fasting 75-gram oral glucose tolerance test (OGTT) but with higher or lower diagnostic cut-points. Our study focused on women with OGTT results between these two sets of thresholds, which we considered “grey zone” results. Objectives: To assess the association of higher versus lower cut-points in the second step of the OGTT with adverse maternal and neonatal outcomes. Specifically, to examine the risk of large for gestational age (LGA) and secondary outcomes among women with GDM screening test results in the grey zone who were not diagnosed for GDM with women who also had grey zone results but received a GDM diagnosis. Methods: We conducted a retrospective cohort study of pregnant women undergoing GDM screening tests between September 01, 2013, and February 29, 2020, at two Montreal-area university hospitals (the Jewish General Hospital [JGH] and McGill University Hospital Centre [MUHC]). Both follow the Diabetes Canada preferred two-step diagnostic approach. However, the JGH uses the Diabetes Canada thresholds with higher cut-points for the OGTT, whereas the MUHC uses lower cut-points. We applied logistic regression models to evaluate the associations with LGA and binary secondary outcomes. For analyses of birthweight and length of hospital stay, we used linear and Poisson regression, respectively. Results: Of 4407 pregnancies evaluated, 836 met inclusion criteria. Untreated women with grey zone results were less likely to have induction of labour compared with those with similar test results who were treated (OR 0.27, 95% CI 0.10, 0.64), and though inconclusive, had an increased OR point estimate for LGA (OR 2.14, 95% CI 0.86, 5.61). Conclusion: Women with mild hyperglycemia during pregnancy who are not currently diagnosed with or treated for GDM may benefit from intervention to reduce the risk of fetal overgrowth, and they are less likely to have induction of labour compared with women with mild hyperglycemia who are diagnosed with GDM. Further research is needed to determine whether lower diagnostic thresholds can improve pregnancy outcomes.
Medication Continuity Following Release from Correctional Facilities: A Landscape Analysis of Provincial Policies in Canada
2Max Bell School of Public Policy, McGill University, Montreal, QC, Canada
Corresponding Author: Anmol Gupta, email: anmol.gupta2@mail.mcgill.ca
Abstract
Background Justice-involved persons have a higher rate of chronic physical and mental health challenges compared to the general population. Federal and provincial or territorial (P/T) governments in Canada share jurisdiction over correctional institutions and the delivery of correctional health care. At any time, there are close to 40,000 incarcerated individuals in Canada. Most incarcerated individuals are released back into society, where the continuation of medical care can be precarious. The literature suggests that these individuals have a high rate of mortality in the weeks after release and face increased difficulties establishing primary care when compared to the general population. Of particular concern is the continuation of essential medication access after release. Currently, there is no analysis of the various federal and P/T policies that govern the provision of medications to individuals upon their discharge to ensure continuity during their return to community. Objectives To describe policy variations in medication supply upon release from incarceration across Canada. Methods A standardized search was used in the Canadian Legal Information Institute database to identify federal and P/T legislation relating to corrections. Sections relating to healthcare delivery, discharge planning and procedures, and release were identified and evaluated for provisions regarding medication supply. Results Of the fourteen jurisdictions assessed, only the federal government, Saskatchewan, Nova Scotia, and Ontario were identified to require the direct provision of non-narcotic medications upon discharge. The federal government and Saskatchewan provide up to 14-days of non-narcotic medicines. Nova Scotia provides a 14-day supply via direct provision or prescription while Ontario does not specify a required amount. PEI was the only jurisdiction to offer access to methadone upon discharge. All other P/Ts had no identifiable policy. Conclusion Most Canadian jurisdictions lack policies to guarantee the supply of essential medications upon an individual’s release from incarceration. Among jurisdictions with policy, the Saskatchewan and federal governments provide the most comprehensive and consistent medication supply. Given the national shortage in primary care, improvements in the provision of medication should be considered across all jurisdictions to protect this vulnerable population and reduce health disparities experienced after release from incarceration.
Culturally Adapted Family Psychoeducation for Psychosis: Preliminary Findings From A Scoping Review
2University of Regina, Regina, SK, Canada
Corresponding Author: Hani Rukh-E-Qamar, email: rukh.rukheqamar@mcgill.ca
Abstract
First-episode psychosis (FEP) often occurs during a time of identity formation in young adulthood, and families and caregivers are often heavily involved in care. Family psychoeducation, a form of psychosocial intervention, is effective in helping families support their loved ones through FEP. However, traditional psychoeducation programs are often based on a biomedical framework and do not address religion, spirituality, or cultural differences, which can be important for many patients and families. The current scoping review aimed to gather the extant literature on culturally adapted psychoeducation for families to; (1) appraise the extent to which, and ways in which, psychoeducation interventions have been culturally adapted for the families of patients with first-episode psychosis (FEP); and (2) highlight aspects of psychoeducation for the families of individuals with first-episode psychosis (FEP) that could enhance participation and recovery. A search strategy was developed working alongside a librarian at McGill University. Four databases were used to acquire citations of relevant studies in this review: Embase (Ovid), Medline (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid). Covidence, a web-based tool for streamlining literature reviews, was used to expedite the first and second screening of the articles. In total, 4375 articles were imported from databases, from which, 1137 articles were removed as duplicates. After this, 3008 studies were deemed irrelevant to our objectives, and from here, about 230 articles are currently being screened using their full texts. The preliminary results of the review include the importance of cultural adaptation to psychoeducation interventions for psychosis and schizophrenia in improvements on symptom reduction, global functioning, stigma perceptions, coping skills, social functioning, quality of life, and attitudes towards medication. Overall, there is a need to incorporate cultural elements, including language, and beliefs, into psychoeducation programs for families of patients with psychosis and schizophrenia.
Do Black people perceive racial discrimination in health care similarly? A qualitative study of primary health care experiences in Montreal, Canada
2St. Mary’s Research Center, St. Mary’s Hospital Center, Montreal, QC, Canada
Corresponding Author: Khandideh K. A. Williams, email: khandideh.williams@mail.mcgill.ca
Abstract
Background: A growing body of literature reveals persistent health disparities within Black communities in Canada. At the same time, numerous studies stemming from the USA demonstrate the adverse effects of racial discrimination on the health care experiences of Black patients. Yet, unlike in the USA where racial disparities are routinely tracked, racialized trends in health care are not systematically captured in Canada. Investigating the ways through which anti-Black racial discrimination impact health care encounters is crucial towards effectively addressing racial health disparities experienced by Black people in Canada. Objectives: Using a qualitative descriptive study design, the objective of this study is to describe perceptions of anti-Black racial discrimination within primary health care services in Montreal, Canada, both before and during the COVID-19 pandemic. Methods: Purposive maximal variation and snowball sampling were employed to recruit self-identified Black persons aged 18 years and older who: 1) lived in Montreal during the COVID-19 pandemic, 2) could speak English or French, and 3) were registered with the Quebec health insurance program. Data were collected from October 2021 to July 2022 via semi-structured in-depth telephone interviews. A thematic analysis approach informed by intersectionality theory was used to identify themes relating to perceived racial discrimination in primary health care encounters. Results: Thirty-two participants were interviewed. Participant accounts highlighted nuances regarding the ways through which racial discrimination is manifested in a Canadian health care context. We identified several themes relating to such complexities, ranging from 1) no perceptions of differential treatment or a desensitization to racial discrimination, 2) subtle forms of racial discrimination or microaggressions, and 3) overt forms of disparate treatment. The dismissal of health concerns and experiences of microaggressions influenced by anti-Black stereotypes were among the most frequent experiences recounted. Experiences of perceived racial discrimination also appeared to be complicated by participants' intersecting social locations like immigration history, age, and gender. Conclusion: Our findings suggest that strategies aimed at redressing health and health care inequities must consider the diversity within Black populations and associated nuances in how racial discrimination is perceived and experienced.
Are all antiretroviral therapy classes equal in achieving viral suppression in women living with HIV? Real-world data analysis to better tailor care.
2Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
3Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
4Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
5Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
Corresponding Author: Alexandra de Pokomandy, email: alexandra.depokomandy@mcgill.ca
Abstract
Background. Female sex is associated with increased susceptibility to HIV, and people identifying as women living with HIV (WLWH) deal with unique challenges. Women are less likely than men to adhere to antiretroviral therapy (ART), jeopardizing their health. ART suppresses HIV load to undetectable levels, allowing people living with HIV (PLHIV) to lead healthier lives. With current ART advances, the adherence threshold is unclear, and emerging evidence suggests it may be lower, yet the standard is a 95% threshold. This can be dispiriting to patients and may lead to treatment disruptions. The advised initial ART treatment includes 2 nucleoside reverse transcriptase inhibitors, combined with a 3 rd agent from 1 of 3 drug classes. Integrase strand transfer inhibitors (INSTI) as a 3rd agent have been shown as more effective in attaining viral suppression, and more forgiving with lower adherence. Objectives. 1a) to describe the ART combinations taken by WLWH in Quebec, Ontario and British Columbia; 1b) to document change of ART over 3 years and the main reasons for change; 1c) to measure the adherence threshold associated with viral suppression among the same WLWH, according to the 3rd agent drug class; and 2) to measure the association between 3rd agent drug class and viral suppression among a population of PLHIV in Quebec. Methods. For the 1st objective(s), I will use the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, where 1422 WLWH in Quebec, Ontario and British Columbia completed peer-assisted surveys at baseline, 18-, and 36-months from 2013 to 2018. Descriptive statistical analyses will be used, and a Sankey diagram will show transitions in 3rd agent class. For the 2 nd objective, I will use the Quebec HIV Cohort, built from clinical databases that include more than 6000 PLHIV that received HIV care in 2021, and use a logistic regression, stratifying by gender and adjusting for confounders. A patient-partner will be involved throughout. Anticipated results. I hypothesize that over 3 years, a majority of WLWH were switched to an INSTI and that with INSTI, viral suppression was achieved with lower adherence, and compared to other drug classes, INSTIs are associated with higher viral suppression, but gender differences may be present. Implications. This will provide current evidence to guide patient-provider discussions on adherence, which would reduce barriers to retention in HIV care, and contribute to improving person-centred care for PLHIV.
Gender Differences in COVID-19 Related Beliefs and Practices of Orthodox Jews in Montreal
2Department of Oncology, McGill University, Montreal, QC, Canada
3Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
4Safe Medical Care, Canadian Medical Protective Association, Ottawa, ON, Canada
Corresponding Author: Natoya Bent, email: natoya.bent@mail.mcgill.ca
Abstract
Background: The COVID-19 pandemic highlighted the disproportionate impact of communicable diseases on minority groups, including the Orthodox Jewish community. Men and women have experienced the pandemic differently as evidenced by mortality being 1.5 times higher in men than women based on data from 129 countries. Gender consists of socially constructed norms that determine roles, relationships, and positional power in society. It has been found that, due to cultural structures, men are less aware of health information and less motivated to locate such information. No studies have been conducted thus far on the role of gender in understanding the differential experiences of COVID-19 within Orthodox Jewish communities. Gender roles are strictly defined in this community and align with biological sex. With its breadth of sub-groups and specific gender roles based on Jewish Law, the Orthodox Jewish community of Montreal presents an ideal opportunity to investigate the relationship between gender and communicable diseases. Objective: To investigate the role of gender in differential reporting of COVID-19 experiences, including behaviours and healthcare satisfaction, within Orthodox Jewish communities in Montreal. Methods: This study is embedded within an interdisciplinary mixed methods project conducted in partnership with the Orthodox Jewish community of Montreal. Data are obtained from a modified version of the Canadian Immunity Taskforce (CITF) Core Data Elements Survey. Our cross-sectional sample includes adults who intended to receive the COVID-19 vaccine; data were collected between June 23 rd 2021 and May 1 st 2022. The main outcome measures were compliance with COVID-19 public health measures, and satisfaction with healthcare. Responses were elicited using Likert scales. Analysis was done using R Studio 4.2.2. Descriptive statistics were undertaken and compared by sex. Results: Our sample consisted of 224 adults, 120 men and 104 women. The mean age of participants was 36 years in both sexes. Women reported greater compliance with public health measures: mask-wearing (86% vs 50%), physical distancing (63% vs 36%), limiting contact with high-risk individuals (60% vs 46%), avoiding common greetings (51% vs 28%), and crowded gatherings (39% vs 19%). Men reported greater compliance with self-isolation (54% vs 46%). Women were also more satisfied with healthcare services (71% vs 64%). Conclusion: Our study highlights significant gender-based discrepancies in compliance with public health measures as well as healthcare satisfaction. To achieve greater compliance, public-health interventions should address intersectional aspects of minority group experience, in this case, the combination of religion and gender. Public health measures should, thus, be designed to account for culturally-based and contextual aspects of minority group experience that affect behaviours related to communicable disease.
Measuring the quality of patient-provider relationships in serious illness: A scoping review
2Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
3Research Institute, McGill University Health Centre, Montréal, QC, Canada
Corresponding Author: Karen Wassef, email: karen.wassef@mail.mcgill.ca
Abstract
Background: High-quality clinical relationships between seriously ill patients and palliative care providers are crucial owing to the deeply personal and complex nature of preventing and alleviating suffering from early diagnosis to end of life. These relationships can enhance patients’ ability to cope with serious illness and promote a peaceful and dignified death. Thus, a comprehensive review of measurement tools designed to assess the quality of these relationships is needed for effectively providing care and improving well-being among seriously ill patients. Objectives: This scoping review aims to provide an overview of existing tools assessing the quality of patient-physician relationships in serious illness care. Methods: A scoping review will be conducted, informed by Arksey and O’Malley (2005), using PRISMA guidelines. A search strategy was designed to identify peer-reviewed articles from PubMed, Embase, CINAHIL, and Ovid MEDLINE. Quantitative, qualitative, and mixed-method studies will be considered for inclusion. No restrictions based on study design, location, or publication date will be applied. Included articles will be written in the English language. Inclusion criteria include: (1) original research, (2) studies which assessed quality of patient- physician relationships in the context of serious illness, and (3) studies in which care was provided in a hospital/clinic setting. Anticipated Results: We expect to find a range of assessment tools used in serious illness care to characterize and evaluate the nature of patient-physician relationships, including relational factors like trust and therapeutic alliance. Conclusion/Implications: Identifying current measurement tools that evaluate the quality of patient-physician relationships in serious illness settings can enhance clinicians’ understanding of the qualities of clinical encounters that manifest patients’ comfort and security when sharing their psychosocial and health-related concerns. Such understanding can improve these relationships in practice and promote patient-centered care. In addition, clinical training can inform clinicians in palliative care settings about how best to cultivate effective modes of interpersonal interaction to build rapport with their seriously ill patients and relieve psychological distress, which is prevalent among this population. Conducting a review of these instruments may thus inform clinical training and potentially improve palliative care service delivery.
Learning from Virtual Interviews in Family Medicine Residency Programs during the COVID-19 Pandemic: A Cross-Sectional Survey Study
2Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
3Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
4Mila - Quebec Artificial Intelligence Institute, Montréal, QC, Canada
Corresponding Author: Raymond Tolentino, email: raymond.tolentino@mail.mcgill.ca
Abstract
Background: During the COVID-19 pandemic, in-person interviews for the recruitment of family medicine residents shifted to online (virtual) interviews. Objectives: The purpose of this study was twofold: (1) to gather the ideas about virtual interviews of family medicine applicants (interviewees), and faculty and staff who interviewed these applicants (interviewers), and (2) describe interviewers and interviewees’ opinions of use of novel technologies such as artificial intelligence (AI) and virtual reality (VR) in the recruitment process as well as during clinical practice. Methods: This was a cross-sectional survey study. Participants were both interviewers and candidates who applied to the McGill University Family Medicine Residency Program for the 2020-2021 and 2021-2022 cycles. Results: The study population was constituted by N = 132 applicants and N=60 interviewers. The response rate was 91.7% (55/60) for interviewers and 43.2% (57/132) for interviewees. Both interviewers (43.7) and interviewees (68.5%) were satisfied with connecting through virtual interviews. Both interviewers (43.75%) and interviewees (55.5%) would prefer for both options to be available. Interviewees are more interested and eager in novel technologies compared to interviewers. Conclusion: Although experience of virtual interviewing during the COVID-19 pandemic has been positive for both interviewees and interviewers, the findings of this study suggest that it will be unlikely that virtual interviews completely replace in-person interviews for selecting candidates for family medicine residency programs in the short term. Since incoming family medicine physicians seem to be eager to learn and utilize novel technologies, educators and institutions should consider family physicians’ needs due to the changing technological landscape in family medicine education.
Unpacking Northwestern Ontario’s sexual assault evidence kits: a mixed methods approach to understanding the barriers to care for survivors
Corresponding Author: Sydney Timmermans, email: sydney.timmermans@mail.mcgill.ca
Abstract
Background: Sexual assault evidence kits (SAEKs) are used to gather forensic evidence from survivors following sexual assault. Without this evidence, legal action may be more difficult to pursue. Furthermore, forensic evidence collection coincides with comprehensive post-assault care and referrals to follow-up services. One third of Canadian women have experienced sexual assault, yet many hospitals lack staff trained in SAEKs and sexual assault care. Most of these deficits fall in remote areas, forcing survivors to travel long distances to receive care; Northern and Indigenous communities are known to especially lack access to comprehensive sexual assault care and SAEKs. This lack of resources often results in re-traumatization and poor survivor mental health. Objectives: My objectives are to gain insight into the current state of post-sexual assault care in Northwestern Ontario from the perspective of healthcare providers, and to assess challenges to SAEK access in the North, with the ultimate aim of informing better access to care. Methods: We employed a sequential, explanatory mixed methods design. An online survey of healthcare providers working in 11 communities based in Northwestern Ontario was completed. The questionnaire was used to gain an overall picture of Northern healthcare providers’about the access to SAEKs in their communities. The survey was followed by nine in-depth semi-structured interviews with healthcare providers from Northwestern Ontario. The interviews covered content about barriers and facilitators to providing sexual assault care, as well as psychosocial supports available to practitioners and the training they have received. Interview transcripts are being analyzed using thematic analysis. Anticipated Results: It is anticipated that results will reveal a paucity of training in relation to sexual assault care, especially in rural centers lacking specialized sexual assault units. We also anticipate that as a result of these deficiencies, urban centers will experience an increase in patients from their rural catchments areas, which may cause difficulties maintaining care. Conclusion/Implications: Sexual assault trauma hinders many survivors from seeking care, especially when care has been inadequate in the past. It is essential that few barriers deter post-assault care, and that the care received is comprehensive and trauma-informed. This research will provide further insight into the rural health challenges of Northern Canada.
The Known Unknowns of Trans Male Sexual Healthcare
2Department of Pediatrics, McGill University, Montreal, QC, Canada
Corresponding Author: Tobias Gurl, email: tobias.gurl@mail.mcgill.ca
Abstract
Background: Trans men are a vulnerable subset of men who face barriers in accessing adequate sexual healthcare. Although their needs overlap with those of cisgender women and men, trans men face distinct physical and psychological challenges related to their gender identity and the process of medical transition. Additionally, existing materials primarily focus on sexually transmitted infections such as HIV and HPV. Although STIs are worthy subjects of study, they do not account for the entirety of sexual healthcare. Conditions such as endometriosis, genito-pelvic pain/penetration disorder, urinary tract infections, and yeast infections, can dramatically impact the quality of life for trans men. Objectives: We aim to answer the following questions: (1) What is the proportion of transgender men seeking out non-STI sexual healthcare compared to cisgender men and women? and (2) What are their experiences with healthcare providers, including factors related to satisfaction, (dis)comfort, and inclination to seek out future care? Methods: This systematic mixed studies review will draw from empirical studies according to a search strategy developed in consultation with a specialized librarian. Convergences and divergences between quantitative results and qualitative findings will help paint a clearer picture of who is seeking care, what they are seeking care for, and their experiences along the way. Anticipated Results: We anticipate that the literature review will indicate pervasive deficits in both the quantity of research performed and in the treatment of trans male sexual health. We anticipate that low economic resources and an expectation of substandard care grounded in past experiences and community narratives will contribute to a decreased likelihood of seeking out care for non-STI sexual health conditions, but that the resulting discrepancies can be reduced through culturally competent and financially accessible services as well as medical providers trained in caring for trans men. Implications: Sexual health is as essential for wellbeing as any other medical discipline, and it should be as accessible and well-studied for transgender men as it is for any other population. A systematic review of the current state of non-STI sexual healthcare will serve as an initial step toward improving patient outcomes and confidence in medical care.
Reducing Depression in the Elderly with Duet Bike
2Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
3Menno Hospital, Abbotsford, BC, Canada
Corresponding Author: Victor Kang, email: victor.kang@mail.mcgill.ca
Abstract
Background: Depression has been found to be one of the most common mental disorders found in the geriatric population in long-term care homes. Recent studies in the UK and the USA have shown promise that taking seniors outdoors with depression improves their quality of life. A duet bike is a specially designed wheelchair bike that allows hospital residents can sit at the front of the bike and be and be taken outdoors and engaged in a bike ride. Objective: The goal of this quality improvement project is to analyze if taking out geriatric patients outdoors will improve their Geriatric Depression Scale (GDS) score. Methods: The study will follow the Plan-Do-Study-Act (PDSA) model. There will be a total of two cycles: one cycle containing intensive rides (a minimum of 5 rides in three weeks) with maintenance rides (one ride per week), and the second cycle only containing intensive rides. There will be two different set of patients for each cycle. Each cycle will commence with a pre-GDS score for each patient and post-GDS score after their cycle. Furthermore, after every bicycle ride, each patient will complete a Patient Satisfaction Survey participation, interaction, and behavior and mood. Results: From a total of 78 eligible rides from 11 studied participants, there was an average decrease of 2.4 points on the GDS. Our study also seems to indicate that individuals scoring moderately on the GDS (between 6-10 out of 15) showed the most improvement on their GDS, while patients who are not severely depressed (1-5) or are severely depressed (11-15) did not show much improvement with the duet bikes. Conclusion: Our study also shows that even with maintenance rides post-intensive rides, the GDS on average decreased by 2 points. Our results suggest that the Duet Bike can be incorporated into homes to assist in decreasing an individual’s depression scores.
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