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Cooper A, Lewis R, Gal M, Joseph-Williams N, Greenwell J, Watkins A, Strong A, Williams D, Doe E, Law RJ, Edwards A. Informing evidence-based policy during the COVID-19 pandemic and recovery period: learning from a national evidence centre. Glob Health Res Policy 2024; 9:18. [PMID: 38822437 PMCID: PMC11140997 DOI: 10.1186/s41256-024-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic demonstrated the vital need for research to inform policy decision-making and save lives. The Wales COVID-19 Evidence Centre (WCEC) was established in March 2021 and funded for two years, to make evidence about the impact of the pandemic and ongoing research priorities for Wales available and actionable to policy decision-makers, service leads and the public. OBJECTIVES We describe the approaches we developed and our experiences, challenges and future vision. PROGRAM IMPLEMENTATION The centre operated with a core team, including a public partnership group, and six experienced research groups as collaborating partners. Our rapid evidence delivery process had five stages: 1. Stakeholder engagement (continued throughout all stages); 2. Research question prioritisation; 3. Bespoke rapid evidence review methodology in a phased approach; 4. Rapid primary research; and 5. Knowledge Mobilisation to ensure the evidence was available for decision-makers. MAIN ACHIEVEMENTS Between March 2021-23 we engaged with 44 stakeholder groups, completed 35 Rapid Evidence Reviews, six Rapid Evidence Maps and 10 Rapid Evidence Summaries. We completed four primary research studies, with three published in peer reviewed journals, and seven ongoing. Our evidence informed policy decision-making and was cited in 19 Welsh Government papers. These included pandemic infection control measures, the Action Plan to tackle gender inequalities, and Education Renew and Reform policy. We conducted 24 Welsh Government evidence briefings and three public facing symposia. POLICY IMPLICATIONS Strong engagement with stakeholder groups, a phased rapid evidence review approach, and primary research to address key gaps in current knowledge enabled high-quality efficient, evidence outputs to be delivered to help inform Welsh policy decision-making during the pandemic. We learn from these processes to continue to deliver evidence from March 2023 as the Health and Care Research Wales Evidence Centre, with a broader remit of health and social care, to help inform policy and practice decisions during the recovery phase and beyond.
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Affiliation(s)
- Alison Cooper
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales.
- Division of Population Medicine, Cardiff University, Cardiff, Wales.
| | - Ruth Lewis
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Micaela Gal
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Natalie Joseph-Williams
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Jane Greenwell
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Angela Watkins
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Alexandra Strong
- Public Contributor, WCEC Public Partnership Group, Bangor, Wales
| | - Denitza Williams
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Elizabeth Doe
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | | | - Adrian Edwards
- Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Bangor, Wales
- Division of Population Medicine, Cardiff University, Cardiff, Wales
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Kapsalis E, Jaeger N, Hale J. Disabled-by-design: effects of inaccessible urban public spaces on users of mobility assistive devices - a systematic review. Disabil Rehabil Assist Technol 2024; 19:604-622. [PMID: 35984675 DOI: 10.1080/17483107.2022.2111723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/21/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Despite the increase of users of Mobility Assistive Devices (MobAD), there has been a lack of accessibility in urban environments in many parts of the world. We present a systematic review of how the inaccessible design of public spaces affects quality-of-life - including aspects of health and safety, independence, and social participation - of MobAD users. MATERIALS AND METHODS We conducted a literature search in three databases (i.e., Scopus, Web of Science, and PubMed) and initially discovered 3980 publications. We analysed 48 peer-reviewed journal articles published in English from 2005 to 2021 and assessed their quality of evidence via the Mixed Methods Appraisal Tool. RESULTS Findings indicated a substantial number of inaccessible elements for MobAD users in public spaces. Pathway characteristics, boarding ramps, entrance features, confined spaces, and service surfaces were deemed to be the least accessible elements. These barriers had multifaceted effects on MobAD users' quality of life with aspects of physical health, mobility, and use of public transport being most affected. CONCLUSIONS Notwithstanding that the reviewed studies mostly ocused on wheelchair users residing in high-income countries, this review outlines the critical role of the design of the built environment as a factor of disablement for MobAD users. We conclude by highlighting a few recommendations for future research and practice, especially inclusive approaches and adaptive techniques to assist MobAD users with performing tasks in public spaces independently.Implications for RehabilitationUsers of Mobility Assistive Devices experience a lack of accessibility provisions in public open spaces and buildings internationally.Physical barriers in public spaces substantially diminish the health and safety, autonomy, and social participation of users of Mobility Assistive Devices.There is a definite need for the adoption of inclusive strategies and adaptive techniques in placemaking processes so that users of Mobility Assistive Devices can have equitable access to public spaces.
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Affiliation(s)
- Efthimis Kapsalis
- Department of Architecture and Built Environment, University of Nottingham, Nottingham, United Kingdom
| | - Nils Jaeger
- Department of Architecture and Built Environment, University of Nottingham, Nottingham, United Kingdom
| | - Jonathan Hale
- Department of Architecture and Built Environment, University of Nottingham, Nottingham, United Kingdom
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Klee I, Büscher H, Groß-Kunkel A, Pfaff H, Gouzoulis-Mayfrank E, Groß SE. [Oncologic Care of Breast Cancer Patients with Preexisting Disabilities: Results of a Qualitative Study on Perceived Barriers, Communication Difficulties, and Needs]. DAS GESUNDHEITSWESEN 2023; 85:1168-1172. [PMID: 36478562 DOI: 10.1055/a-1967-9960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.
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Affiliation(s)
- Inna Klee
- Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung, LVR-Klinik Köln, Köln, Germany
| | - Hannah Büscher
- Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung, LVR-Klinik Köln, Köln, Germany
| | - Anke Groß-Kunkel
- Department Heilpädagogik und Rehabilitation, Humanwissenschaftliche Fakultät Universität zu Köln, Köln, Germany
| | - Holger Pfaff
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR), Humanwissenschaftliche und Medizinische Fakultät der Universität zu Köln, Köln, Germany
| | | | - Sophie Elisabeth Groß
- Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung, LVR-Klinik Köln, Köln, Germany
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Palityka D, Chrysikou E, Murtagh N. Accessible art in healthcare facilities: exploring perspectives of healthcare art for visually impaired people. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1205361. [PMID: 37937067 PMCID: PMC10627155 DOI: 10.3389/fmedt.2023.1205361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Art in healthcare facilities shows promising results in improving patients' health and well-being and, as such, meets the WHO's definition of health technology. Yet, it remains unclear if healthcare art equally benefits all users. Given the growing number of visually impaired people (VIP), it is valuable to determine whether healthcare art is accessible to VIP and to explore strategies for improving it. Methods This study employed a mixed methodology, which included (1) secondary research of 25 cases of healthcare art programmes to identify the presence of accessible art in healthcare facilities and the practices that influence it; (2) review of thirty-one Health Building Notes and four supplementary British guidelines on healthcare art to discover if the accessibility of art is required and identify which recommendations influence it; and (3) interview surveys of healthcare art practitioners from three London NHS Trusts to identify opportunities to increase arts accessibility. Results and discussion The evidence showed that healthcare art programmes were mostly inaccessible to VIP. Most healthcare art programmes did not involve VIP in the commissioning process and, thus, lacked procedures that could facilitate accessibility. There were not enough recommendations in the healthcare facility guidelines to support the accessibility of arts for VIP. The recommendations on artwork in healthcare facility guidelines could increase accessibility if particular conditions were met. Interviews with NHS trusts in London revealed numerous opportunities to improve arts accessibility for healthcare art programmes.
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Affiliation(s)
- Daryia Palityka
- The Bartlett School of Sustainable Construction, University College London, London, United Kingdom
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Cho MK, Duque Lasio ML, Amarillo I, Mintz KT, Bennett RL, Brothers KB. Words matter: The language of difference in human genetics. Genet Med 2023; 25:100343. [PMID: 36524987 PMCID: PMC9991958 DOI: 10.1016/j.gim.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Diversity, equity, and inclusion efforts in academia are leading publishers and journals to re-examine their use of terminology for commonly used scientific variables. This reassessment of language is particularly important for human genetics, which is focused on identifying and explaining differences between individuals and populations. Recent guidance on the use of terms and symbols in clinical practice, research, and publications is beginning to acknowledge the ways that language and concepts of difference can be not only inaccurate but also harmful. To stop perpetuating historical wrongs, those of us who conduct and publish genetic research and provide genetic health care must understand the context of the terms we use and why some usages should be discontinued. In this article, we summarize critiques of terminology describing disability, sex, gender, race, ethnicity, and ancestry in research publications, laboratory reports, diagnostic codes, and pedigrees. We also highlight recommendations for alternative language that aims to make genetics more inclusive, rigorous, and ethically sound. Even though norms of acceptable language use are ever changing, it is the responsibility of genetics professionals to uncover biases ingrained in professional practice and training and to continually reassess the words we use to describe human difference because they cause harm to patients.
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Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA; Departments of Medicine and Pediatrics, Stanford University, Stanford, CA.
| | - Maria Laura Duque Lasio
- Division of Genetics & Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO; Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ina Amarillo
- Department of Pathology and Laboratory Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Kevin Todd Mintz
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA
| | - Robin L Bennett
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Kyle B Brothers
- Norton Children's Research Institute Affiliated with the University of Louisville, Louisville, KY
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Descriptive phenomenology study of the reasons for the low uptake of free health service package among type II diabetic patients. BMC Health Serv Res 2022; 22:1555. [PMID: 36539819 PMCID: PMC9764735 DOI: 10.1186/s12913-022-08953-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although several diabetes management and control programs are introduced in Iran, rate of using such cares in patients with Type II Diabetic in Ahvaz is low and they show no tendency for receiving free diabetes service package. The aim of this study was to identify reasons behind low uptake of free health service package among T2DM patients in Ahvaz, Iran. METHODS This descriptive phenomenology study based on semi-structured guided interviews of patients with Type II Diabetic in Ahvaz, was carried out in the year 2021. Through purposeful sampling, 495 patients with diabetics who not received health services package more than 6 months were interviewed until the data saturation. The gathered data were analyzed through conventional content analysis. RESULTS Reasons were categorized into three themes which include 13 subthemes and 57 codes. Themes included individual, accessibility, and structural factors. Besides, subthemes were lack of awareness, poor health literacy, adverse patients experience, difficulties to use services, verbal miscommunication cultural barriers, low trust, geographic barriers, time barriers, financial difficulties, lack of human resources, poor service delivery, and organizational factors were as barriers to participation. CONCLUSION Regarding individual level, there is a need for further training of diabetic patients. Besides, for accessibility and structural factors Iranian healthcare system needs a comprehensive integrated care for the management of diabetes, this underlines the collaboration for improving patients' uptake of free health service package.
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Binkley CE, Reynolds JM, Shuman A. From the Eyeball Test to the Algorithm - Quality of Life, Disability Status, and Clinical Decision Making in Surgery. N Engl J Med 2022; 387:1325-1328. [PMID: 36198184 DOI: 10.1056/nejmms2207408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Charles E Binkley
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
| | - Joel Michael Reynolds
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
| | - Andrew Shuman
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
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Yamagami M, Mack K, Mankoff J, Steele KM. “I’m Just Overwhelmed”: Investigating Physical Therapy Accessibility and Technology Interventions for People with Disabilities and/or Chronic Conditions. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2022. [DOI: 10.1145/3563396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Many individuals with disabilities and/or chronic conditions (da/cc) experience symptoms that may require intermittent or on-going medical care. However, healthcare is an often-overlooked domain for accessibility work, where access needs associated with temporary and long-term disability must be addressed to increase the utility of physical and digital interactions with healthcare workers and spaces. Our work focuses on a specific domain of healthcare often used by individuals with da/cc: physical therapy (PT). Through a twelve-person interview study, we examined how people’s access to PT for their da/cc is hampered by social (e.g., physically visiting a PT clinic) and physiological (e.g., chronic pain) barriers, and how technology could improve PT access. In-person PT is often inaccessible to our participants due to lack of transportation and insufficient insurance coverage. As such, many of our participants relied on at-home PT to manage their da/cc symptoms and work towards PT goals. Participants felt that PT barriers, such as having particularly bad symptoms or feeling short on time, could be addressed with well-designed technology that flexibly adapts to the person’s dynamically changing needs while supporting their PT goals. We introduce core design principles (adaptability, movement tracking, community building) and tensions (insurance) to consider when developing technology to support PT access. Rethinking da/cc access to PT from a lens that includes social and physiological barriers presents opportunities to integrate accessibility and adaptability into PT technology.
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Affiliation(s)
- Momona Yamagami
- Department of Electrical & Computer Engineering, University of Washington, Seattle, USA
| | - Kelly Mack
- Department of Computer Science & Engineering, University of Washington, Seattle, USA
| | - Jennifer Mankoff
- Department of Computer Science & Engineering, University of Washington, Seattle, USA
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle, USA
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Chen A, Väyrynen K, Schmidt A, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The impact of implementing patient-reported measures in routine maternity care: a systematic review. Acta Obstet Gynecol Scand 2022; 101:1184-1196. [PMID: 36065150 PMCID: PMC9812106 DOI: 10.1111/aogs.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. MATERIAL AND METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). RESULTS Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. CONCLUSIONS The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.
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Affiliation(s)
- An Chen
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland,Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Riikka‐Leena Leskelä
- Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Paulus Torkki
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical ScienceIntervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden,Women's Health and Perinatology Research Group, Department of Clinical MedicineUiT ‐ The Arctic University of NorwayTromsøNorway
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Chan DN, Law BM, So WK, Fan N. Factors associated with cervical cancer screening utilisation by people with physical disabilities: A systematic review. Health Policy 2022; 126:1039-1050. [DOI: 10.1016/j.healthpol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/29/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022]
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McWilliams L, Groves S, Howell SJ, French DP. The Impact of Morbidity and Disability on Attendance at Organized Breast Cancer-Screening Programs: A Systematic Review and Meta-Analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:1275-1283. [PMID: 35511754 PMCID: PMC9377755 DOI: 10.1158/1055-9965.epi-21-1386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/01/2022] [Accepted: 04/29/2022] [Indexed: 01/07/2023] Open
Abstract
Individuals with morbidity experience worse breast cancer outcomes compared with those without. This meta-analysis assessed the impact of morbidity on breast cancer-screening attendance and subsequent early detection (PROSPERO pre-registration CRD42020204918). MEDLINE, PsychInfo, and CINAHL were searched. Included articles published from 1988 measured organized breast-screening mammography attendance using medical records by women with morbidity compared with those without. Morbidities were assigned to nine diagnostic clusters. Data were pooled using random-effects inverse meta-analyses to produce odds ratios (OR) for attendance. 25 study samples (28 articles) were included. Data were available from 17,755,075 individuals, including at least 1,408,246 participants with one or more conditions;16,250,556 had none. Individuals with any morbidity had lower odds of attending breast screening compared with controls [k = 25; OR, 0.76; 95% confidence interval (CI), 0.70-0.81; P = <0.001; I2 = 99%]. Six morbidity clusters had lower odds of attendance. The lowest were for neurological, psychiatric, and disability conditions; ORs ranged from 0.45 to 0.59 compared with those without. Morbidity presents a clear barrier for breast-screening attendance, exacerbating health inequalities and, includes a larger number of conditions than previously identified. Consensus is required to determine a standardized approach on how best to identify those with morbidity and determine solutions for overcoming barriers to screening participation based on specific morbidity profiles.
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Affiliation(s)
- Lorna McWilliams
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Center for Health Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Center, Manchester Academic Health Science Center, Manchester University NHS Foundation Trust, Manchester, England
| | - Samantha Groves
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Center for Health Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sacha J. Howell
- NIHR Manchester Biomedical Research Center, Manchester Academic Health Science Center, Manchester University NHS Foundation Trust, Manchester, England
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - David P. French
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Center for Health Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Center, Manchester Academic Health Science Center, Manchester University NHS Foundation Trust, Manchester, England
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Mitchell RJ, Ryder T, Matar K, Lystad RP, Clay-Williams R, Braithwaite J. An overview of systematic reviews to determine the impact of socio-environmental factors on health outcomes of people with disabilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1254-1274. [PMID: 34850472 DOI: 10.1111/hsc.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people. A systematic search of five databases (MEDLINE, PsycINFO, Embase, CINAHL and Scopus) for English-language articles from January 2000 to April 2021 was conducted. Abstracts were screened by two reviewers and reviews were critically appraised. Key data were extracted by topic, population, disability type, critical appraisal method, socio-environmental themes and health outcomes. There were 23 systematic reviews identified examining adult (60.9%) or child and young (8.7%) disabled people, with 30.4% not specifying an age range. Reviews examined people with neurological or physical (39.1%), intellectual (17.4%), sensory (8.7%) or a range of (34.8%) disabilities. Three key health outcomes (i.e. access to healthcare, health-promoting behaviour and care quality) and several recurring socio-environmental themes related to the health outcomes of disabled people were identified. Disabled people encounter common social, physical and attitudinal factors that hinder their health outcomes in terms of access to services and quality healthcare. Many preventive health services were identified as either inaccessible or not meeting the needs of disabled people. Greater involvement of disabled people in service design and awareness raising is essential.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katia Matar
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1115-1142. [PMID: 35705780 DOI: 10.1007/s11121-022-01388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.
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Affiliation(s)
- Alice Le Bonniec
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France.
| | - Sophie Sun
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Amandine Andrin
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Letrilliart
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
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Fritzell K, Kottorp A, Jervaeus A. Different information needs-The major reasons for calling the helpline when invited to colorectal cancer screening. Health Expect 2022; 25:1548-1554. [PMID: 35393757 PMCID: PMC9327847 DOI: 10.1111/hex.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study pertains to the design of a decision aid (DA) to shed light on information and support needs in colorectal cancer screening, with the aim to explore the calling patterns to the Screening of Swedish Colons (SCREESCO) study's helpline. METHODS A cross-sectional study was conducted with data from documented telephone calls to the SCREESCO study, including individuals, 59-60 years, randomized to colonoscopy or high sensitive faecal immunochemical test (FIT). RESULTS More than 2000 calls (women 58.5%; colonoscopy 59%) were analysed. Calling patterns: unsubscribing from screening, confirmation of participation, logistical concerns about the screening procedure, counselling, and FIT screening difficulties or in need of a new FIT test. Comorbidity was the most frequent reason for unsubscribing and most of the counselling calls included questions about the FIT test or the colonoscopy. CONCLUSION Most of the calls to the helpline seemed to be related to individuals' lack of understanding about the organization of the screening programme and the screening procedure. Therefore, we find it important to further stress the tailoring part in our DA developing process, that is, provide limited information initially, with the possibility of access to more, if desired by the individual, still with respect to the individual's needs, health and digital literacy. PATIENT AND PUBLIC CONTRIBUTION Individuals representing the public and invited to SCREESCO participated since we analysed their calls to the helpline. The findings will contribute to our continued work with the DA where the public will contribute and participate.
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Affiliation(s)
- Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Sayani A, Manthorne J, Nicholson E, Bloch G, Parsons JA, Hwang SW, Amenu B, Freedman H, Rathbone M, Jeji T, Wathen N, Browne AJ, Varcoe C, Lofters A. Toward equity-oriented cancer care: a Strategy for Patient-Oriented Research (SPOR) protocol to promote equitable access to lung cancer screening. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:11. [PMID: 35382905 PMCID: PMC8980795 DOI: 10.1186/s40900-022-00344-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore, the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening. This can lead to a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. METHODS This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning module for healthcare providers. The learning module will describe the social context of lung cancer risk and promote access to lung cancer screening by increasing equity at the point of care. We have applied the Generative Co-Design Framework for Healthcare Innovation and detail our study processes in three phases and six steps: Pre-design (establishing a study governance structure); Co-design (identifying research priorities, gathering and interpreting data, co-developing module content); and Post-design (pilot testing the module and developing an implementation plan). DISCUSSION Patient engagement in research can promote the design and delivery of healthcare services that are accessible and acceptable to patients. This is particularly important for lung cancer screening as those at highest risk of developing lung cancer are also those who are least likely to participate in lung cancer screening. By detailing the steps of our participatory co-design journey, we are making visible the processes of our work so that they can be linked to future outcomes and related impact, and inform a wide range of patient co-led processes.
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Affiliation(s)
- Ambreen Sayani
- Transition to Leadership Stream Postdoctoral Fellow at the Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | | | | | - Gary Bloch
- St. Michael's Hospital and Inner City Health Associates, University of Toronto, Toronto, Canada
- Wellesley Institute, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Bikila Amenu
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Howard Freedman
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Marlene Rathbone
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Tara Jeji
- Research Advisory Council, Lung Cancer Screening Strategy for Patient-Oriented Research Study, Women's College Hospital, Toronto, Canada
| | - Nadine Wathen
- Arthur Labatt Family School of Nursing, Centre for Research on Health Equity and Social Inclusion, Western University, London, Canada
| | - Annette J Browne
- University of British Columbia School of Nursing, Vancouver, BC, Canada
| | - Colleen Varcoe
- University of British Columbia School of Nursing, Vancouver, BC, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, Women's College Hospital Family Practice Health Centre, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
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18
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Iezzoni LI. Cancer detection, diagnosis, and treatment for adults with disabilities. Lancet Oncol 2022; 23:e164-e173. [DOI: 10.1016/s1470-2045(22)00018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
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19
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[Barriers to breast cancer screening for people with disabilities]. Bull Cancer 2021; 109:185-196. [PMID: 34657724 DOI: 10.1016/j.bulcan.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022]
Abstract
A significant increase in breast cancer is expected in the coming decades among people with disabilities. However, their participation rate in screening programs is significantly lower than women without disabilities. Our objective was therefore to analyse the barriers to breast cancer screening in people with disabilities based on a recent review of the international literature. The articles analysed were retrieved from the PUBMED database from 2014 to 2020 using the following keywords "breast cancer", "screening" and "disability". A total of 37 studies were included, including 30 original articles and 7 meta-analyses. The main barriers to performing breast cancer screening for women with disabilities were environmental factors such as lack of adapted transportation means or difficult access to medical facilities and mammography. To a lesser extent, the unsupportive views of family caregivers and health care staff about screening were also barriers to screening acceptance by people with disabilities. In general, breast cancer screening is a useful public health measure that reduces the burden of treatment and breast cancer-related mortality. Screening is useful for women over 50 years of age who have a sufficiently long-life expectancy, generally estimated at more than 10 years. Educational measures are needed to reduce the barriers to screening for PH who meet these criteria, their caregivers, and their providers so that they can actively participate in health care, rather than being marginalized because of their disability.
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20
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Nuche-Berenguer B, Sakellariou D. Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study. Front Public Health 2021; 9:699108. [PMID: 34504827 PMCID: PMC8423085 DOI: 10.3389/fpubh.2021.699108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.
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21
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Understanding how to facilitate continence for people with dementia in acute hospital settings: a mixed methods systematic review and thematic synthesis. Syst Rev 2021; 10:199. [PMID: 34229762 PMCID: PMC8262033 DOI: 10.1186/s13643-021-01743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 06/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People living with dementia (PLWD) are at significant risk of developing urinary and/or faecal incontinence and are also at risk of functional incontinence or being labelled as being incontinent. Despite the growing population of PLWD and importance of continence care, little is known about the appropriate management, organisation, and interactional strategies for PLWD admitted to acute hospitals. This mixed methods systematic review and thematic synthesis sought to identify successful strategies across all care settings that could then be used to inform innovations in continence care for PLWD in the acute hospital setting. METHODS In phase 1, a scoping search of two electronic databases (MEDLINE and PsycINFO) and a consultation with stakeholders was undertaken. Findings were presented to the project steering group and two priority areas for phase 2 were identified which were communication and individualised care plans. In phase 2, eight databases and relevant UK government and other organisational websites were searched for English language citations from inception to August 2020. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT Version 11). Thematic synthesis was employed and the strength of synthesised findings for the intervention studies was assessed using the GRADE approach and the confidence in synthesised qualitative and survey findings was assessed using the CERQual approach. RESULTS In phase 1, 1348 citations were found and 75 included. In phase 2, 6247 citations were found, 14 research studies and 14 policy and guidance documents were included. The quality of studies varied. Material was synthesised into three overarching syntheses which were: communication this is dignified, person-centred and respectful; communication during outpatients apointments and delivering individualised continence care. CONCLUSIONS Recognising that PLWD are not always able to communicate their continence needs verbally is important. Incorporating interpersonal and communication skills into the context of continence care within training for those working with this patient group is crucial for continence to be maintained during an acute admission. Continence care in the acute setting should be tailored to the individual and be developed in partnership with staff and caregivers. TRIAL REGISTRATION PROSPERO: CRD42018119495 .
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22
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Liao CM, Huang WH, Kung PT, Chiu LT, Tsai WC. Comparison of colorectal cancer screening between people with and without disability: a nationwide matched cohort study. BMC Public Health 2021; 21:1034. [PMID: 34078353 PMCID: PMC8170777 DOI: 10.1186/s12889-021-11105-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background The World Health Organization has recognized that people with disability are among the most marginalized in the world. This study’s objective was to investigate the differences in the probability of colorectal cancer (CRC) screening with faecal immunochemical testing (FIT) between people with disability and without disability in Taiwan. Methods The study participants included people with and without disability from the Disability Registration Database (2012) and the National Health Insurance Research Database (2009–2012). The study included 50- to 69-year-olds with and without disability who were screened from 2011 to 2012 and were alive in 2012. There were 16 categories of disability. After propensity score matching (PSM) between the two groups, conditional logistic regression analysis with control variables was used to investigate the odds ratio (OR) that people with or without disability would undergo CRC screening. Results The percentage of people with disability receiving CRC screening was 21.84%, and the highest rate of those receiving CRC screening (38.72%) was found in people with intractable epilepsy, whose OR was 1.47 times that of people with moving functional limitation (95% confidence interval (CI) = 1.17–1.85). The results showed that the probability of CRC screening in people with disability was lower than that in people without disability (OR = 0.88, 95%CI = 0.87–0.89). The probability of receiving CRC screening differed between people with different categories of disability. Conclusions Although the probability of CRC screening in the four categories of disability was higher than that in the general population, overall, people with disability were less likely than people without disability to undergo CRC screening. Health inequalities still exist under National Health Insurance in Taiwan.
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Affiliation(s)
- Chun-Ming Liao
- Department of Public Health, China Medical University, Taichung, Taiwan.,Genetic and Rare Disease Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Hao Huang
- Department of Gastroenterology and Hepatology, Yee Zen General Hospital, Taoyuan City, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan.
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23
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Agaronnik ND, El-Jawahri A, Iezzoni LI. Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer. J Gen Intern Med 2021; 36:1250-1257. [PMID: 33205226 PMCID: PMC8131437 DOI: 10.1007/s11606-020-06327-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mobility disability is the most common disability among adult Americans, estimated at 13.7% of the US population. Cancer prevalence is higher among people with mobility disability compared with the general population, yet people with disability experience disparities in cancer screening and treatment. OBJECTIVE We explored experiences of patients with mobility disability with the process of cancer diagnosis. DESIGN Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis. PARTICIPANTS We interviewed 20 participants with pre-existing mobility disability that required the use of an assistive device or assistance with performance of activities of daily living and who were subsequently diagnosed with cancer (excluding melanoma). KEY RESULTS Concerns coalesced around five broad categories: inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis, attitudes of clinical staff about accommodating disability, dismissal of cancer signs/symptoms as emotional responses to chronic health conditions, misattributing cancer signs/symptoms to underlying disability, and attitudes about pursuing legal action for substandard care. Participants provided examples of how erroneous assumptions and potentially biased attitudes among clinicians interfered with the process of their cancer diagnosis, sometimes contributing to an insufficient workup and diagnostic delays. CONCLUSIONS Physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. Though people with mobility disability may be clinically complex, clinicians should be aware of the risks of diagnostic overshadowing (i.e., the misattribution of cancer signs/symptoms to underlying disability) and other erroneous assumptions that may affect timeliness of cancer diagnosis and quality of care. Further efforts, including educating clinicians about challenges in caring for persons with disability, should be considered to improve the process of cancer diagnosis for this population. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa I Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
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24
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Agaronnik ND, El-Jawahri A, Kirschner K, Iezzoni LI. Exploring Cancer Treatment Experiences for Patients With Preexisting Mobility Disability. Am J Phys Med Rehabil 2021; 100:113-119. [PMID: 33065580 PMCID: PMC7855292 DOI: 10.1097/phm.0000000000001622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We explored the process of cancer care for patients with preexisting mobility disability, focusing on treatment decisions and experiences. DESIGN We recruited 20 participants with preexisting mobility disability, requiring use of an assistive device or assistance with activities of daily living, subsequently diagnosed with cancer (excluding skin cancers). We conducted open-ended individual interviews, which reached data saturation and were transcribed verbatim for conventional content analysis. RESULTS Concerns coalesced around 4 themes: disability-related healthcare experiences affect cancer treatment decisions; concerns about cancer treatment worsening functional impairments; access barriers; and limited provider awareness and biases about treating people with disability. Residual fear from previous medical interventions and concerns about exacerbating functional impairments influenced cancer treatment preferences. Participants also raised concerns that their underlying disability may be used to justify less aggressive treatment. Nevertheless, cancer treatment did exacerbate mobility difficulties for some participants. Inaccessible hospital rooms, lack of accessible medical equipment, and attitudinal barriers complicated treatments. CONCLUSIONS People with preexisting mobility disability experience barriers to cancer treatment, compromising quality of care and potentially outcomes. Further training and proactive planning for accommodating disability during cancer treatment and rehabilitation are warranted. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of the article, the reader should be able to: (1) Recognize inadequate accommodations that compromise the diagnosis and treatment of a new cancer in patients with preexisting disability; (2) Recommend involving rehabilitation specialists in the process of care and clinical decision making from the time of cancer diagnosis for patients with preexisting disability newly diagnosed with malignancy; and (3) In the setting of accessibility barriers, facilitate efforts to accommodate patients with preexisting disability to improve quality of care in diagnosing and treating cancer. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Nicole D Agaronnik
- From the Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts (NDA, LII); Department of Medicine, Harvard Medical School, Boston, Massachusetts (AE-J, LII); Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts (AE-J); Departments of Medical Education, and Neurology and Rehabilitation, University of Illinois College of Medicine, Champaign, Illinois (KK); and Department of Disability and Human Development, College of Allied Health Sciences, University of Illinois, Chicago, Illinois (KK)
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, Campbell EG. Physicians' Perceptions Of People With Disability And Their Health Care. Health Aff (Millwood) 2021; 40:297-306. [PMID: 33523739 PMCID: PMC8722582 DOI: 10.1377/hlthaff.2020.01452] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities. Although many factors likely contribute to these disparities, one little-studied but potential cause involves physicians' perceptions of people with disability. In our survey of 714 practicing US physicians nationwide, 82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly. More than thirty years after the Americans with Disabilities Act of 1990 was enacted, these findings about physicians' perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.
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Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni is a professor of medicine at Harvard Medical School, based at the Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, in Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao is a statistician in the Biostatistics Center at Massachusetts General Hospital and at the Boston University School of Public Health
| | - Julie Ressalam
- Julie Ressalam is a senior research coordinator in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, in Aurora, Colorado
| | - Dragana Bolcic-Jankovic
- Dragana Bolcic-Jankovic is the director of survey operations and a research fellow in the Center for Survey Research at the University of Massachusetts Boston, in Boston, Massachusetts
| | - Nicole D Agaronnik
- Nicole D. Agaronnik is a medical student at Harvard Medical School. When this work was performed, she was a research assistant in the Mongan Institute Health Policy Center, Massachusetts General Hospital
| | - Karen Donelan
- Karen Donelan is the Stuart H. Altman Chair in U.S. Health Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts. At the time this work was performed, she was a senior scientist at the Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School
| | - Tara Lagu
- Tara Lagu is an associate professor in the Institute for Healthcare Delivery and Population Science and the Department of Medicine at Baystate Health and the University of Massachusetts Medical School, in Springfield, Massachusetts
| | - Eric G Campbell
- Eric G. Campbell is a professor and director of research in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado
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Agaronnik ND, El-Jawahri A, Iezzoni LI. Exploring attitudes about developing cancer among patients with pre-existing mobility disability. Psychooncology 2020; 30:478-484. [PMID: 33064885 DOI: 10.1002/pon.5574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Mobility disability affects approximately 13.7% of the United States population, representing the most common disability type. People with mobility disability experience disparities in cancer screening and higher prevalence of some cancers compared to the general population. We sought to explore the attitudes of people with pre-existing mobility disability about their cancer diagnosis. METHODS We conducted open-ended individual interviews with 20 participants who had pre-existing mobility disability requiring use of an assistive device or assistance with performance of activities of daily living (ADLs), subsequently diagnosed with cancer (excluding skin cancers). Interviews reached data saturation and were transcribed verbatim for conventional content analysis. RESULTS Concerns coalesced around three major themes: sense of control over health conditions, seeking support, and recommendations for other people with disability seeking cancer care. Some participants described feeling a loss of control over their cancer diagnosis that they did not have regarding disability, while others suggested that disability presented greater challenges than their cancer diagnosis. Participants described seeking various forms of support, including emotional support (e.g., from friends and family), informational support (e.g., recommendations for seeking care), instrumental support (e.g., ADLs), and appraisal (e.g., self-reflection of personal qualities for fighting cancer). They provided recommendations, highlighting importance of self-advocacy and being attuned to changes in health status. CONCLUSIONS We found that people with pre-existing mobility disability and cancer express complex attitudes towards their cancer diagnosis. Findings may inform efforts to improve quality of relevant supports to meet the psychosocial needs of this population.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa I Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Fremion E, Kanter D, Turk M. Health promotion and preventive health care service guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:513-523. [PMID: 33285642 PMCID: PMC7838968 DOI: 10.3233/prm-200718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Individuals with Spina Bifida (SB) have unique lifelong medical and social needs. Thus, when considering how to promote health and offer preventive care, providers must adapt general healthcare screening and counseling recommendations to their patients' physical and cognitive impairments along with discerning how to monitor secondary or chronic conditions common to the population. This article provides an update on the health promotion and preventive health care guidelines developed as part of the Spina Bifida Association's fourth edition of the Guidelines for the Care of People with Spina Bifida. The guidelines highlight accommodations needed to promote general preventive health, common secondary/chronic conditions such as obesity, metabolic syndrome, hypertension, musculoskeletal pain, and considerations for preventing acute care utilization for the SB population throughout the lifespan. Further research is needed to understand the effectiveness of preventive care interventions in promoting positive health outcomes and mitigating potentially preventable acute care utilization.
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Affiliation(s)
- Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - David Kanter
- Departments of Physical Medicine and Rehabilitation, Pediatrics, and Public Health and Preventive Medicine, UpstateMedical University, Syracuse, NY, USA
| | - Margaret Turk
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
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