Curated Resources
Bouça-Machado, R., Roserio, M., Alarcão, J., Correia-Guedes, L., Abreu, D., & Ferreira, J. J. (2017). Clinical trials in palliative care: a systematic review of their methodological characteristics and of the quality of their reporting. BMC palliative care, 16(1), 10. doi:10.1186/s12904-016-0181-9 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264484/
This article was a systematic review of clinical trials for palliative care interventions. Identified were pharmacological, non- nonpharmacological, complementary non-pharmacological and home based interventions. One hundred and seven controlled clinical trials (CCT) were assessed in two groupings. The first focused on physical, psychological, social and spiritual factors and the second concentrated on communication, symptoms control, family support and team work. The effectiveness of interventions based on pain, breathlessness and nausea were mostly studied, as well as improvement in quality of life. Although the authors state that studies on palliative care interventions have increased in recent years, they note that most studies are still of poor quality. The studies in this review were assessed by the Cochrane Risk of Bias tool and on the checklist of guidelines for the design and evaluation of clinical trials (CONSORT, SPIRIT) and were found to have suboptimal methodology quality. They suggest that using tools such as CONSORT or SPIRIT to help in reporting study outcomes may be a solution to increasing the quality of studies (Bouça-Machado, Roserio, Alarcão, Correia-Guedes, Abreu, & Ferreira, 2017).
Curated Resources
Dangi-Garimella, S. (2016, April 04). Successful intervention improved breast cancer screening rates among Latinos. AJMC. Retrieved from https://www.ajmc.com/newsroom/successful-intervention-improved-breast-cancer-screening-rates-among-latinos
This article discusses the inequity of breast cancer screening in socially disadvantaged Hispanic women in the State of Washington. The author notes that a multilevel intervention in this community, modestly but successfully increased breast cancer screening by 8 % in Hispanic in the intervention arm as compared to the Hispanic women in the control arm of the study. The intervention consisted of a visit by a trained community worker to educate the women on the importance of breast cancer screening. This demonstrates that multilevel interventions involving individuals, clinics and communities have more success than interventions aimed at the individual alone (Dangi-Garimella, 2016).
Curated Resources
Stange, K. C., Breslau, E. S., Dietrich, A. J., & Glasgow, R. E. (2012). State-of-the-art and future directions in multilevel interventions across the cancer control continuum. Journal of the National Cancer Institute. Monographs, (44), 20–31. doi:10.1093/jncimonographs/lgs006 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482971/
This article focuses on the need for multidimensional and multilevel intervention research, particularly in cancer control and prevention. The review comprised of studies that included and assessed contextual components that interacted across different levels. Interventions were assessed in terms of public policy, the environment, communities, health-care organizations, healthcare professionals, families, and individuals. Studies included both qualitative and quantitative research methods. To be successful, the authors suggest that multilevel interventions should consider contextual elements such as settings, historical and cultural dynamics and narrative descriptions. In this way, a deeper understanding would enable the interventions to be applied to an appropriate clinical practice (Stange, Breslau, Dietrich, & Glasgow, 2012).
Curated Resources
Warnecke, R. B., Campbell, R. T., Vijayasiri, G., Barrett, R. E., & Rauscher, G. H. (2019). Multilevel examination of health disparity: The role of policy implementation in neighborhood context, in patient resources, and in healthcare facilities on later stage of breast cancer diagnosis. Cancer Epidemiol Biomarkers Preventions, 28(1) 59-66; DOI: 10.1158/1055-9965.EPI-17-0945 retrieved from http://cebp.aacrjournals.org/content/28/1/59
This article speaks about the ethnic/racial disparity of breast cancer mortality among Black, Hispanic and Caucasian women in the Chicago area. A multilevel analysis was performed to see what factors determined later stage diagnosis of Black and Hispanic women as compared to White women. Results showed that physical environment, access to health care, proper follow up and method of detection all played a role in later stage diagnosis. Socially disadvantaged minority women experience health inequities due to poor quality breast screening programs and facilities, and delays in follow-up and treatment. The authors suggest multilevel interventions to address these disparities focusing on the healthcare system, change in health policies for better screening and follow-up in underprivileged communities (Warnecke, Campbell, Vijayasiri, Barrett, & Rauscher, 2019).
Curated Resources
Rural Health Information Hub. (2019). PRECEDE/PROCEDE. Retrieved from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/program-models/precede-proceed
This article is about the PRECEDE/PROCEDE multilevel intervention model. A multilevel intervention model considers and evaluates health needs in a population and guides in planning, implementing and assessing health promotion and disease prevention in the context and culture of that population.
It evaluates the health determinants of social problems in a community, the behavioral and environmental determinants of lifestyle behaviours, and the public policy factors that could impact on the implementation of interventions. It also sets goals and recognizes the anticipated outcomes of the interventions. Finally, it focuses on the implementation of the program and then evaluates the process, impact and the outcome of the interventions (Rural Health Information Hub, 2019).
Curated Resources
Union for International Cancer Control (UICC). (n. d.). Prevention: Breast cancer risk factors and prevention. Knowledge Summary. Retrieved from https://www.fredhutch.org/content/dam/public/labs-projects/Science-Projects/bci2_5/pdf/UICC_Prevention_Risk_Factors_FA.pdf
This article describes a comprehensive, multilevel approach to breast cancer prevention. Included are the development, implementation and evaluation processes of interventions of primary, secondary and tertiary prevention for breast cancer. The methodology is a multilevel approach that includes individuals, communities, the healthcare systems in place and public health policy. Cultural and contextual factors of the community are taken into consideration with the process (Union for International Cancer Control (UICC), n. d.).
Curated Resources
Agurs-Collins, T., Persky, S., Paskett, E. D., Barkin, S. L., Meissner, H. I., Nansel, T. R., Arteaga, S. S., Zhang, X., Das, R., & Farhatet, T. (2019). Designing and assessing multilevel interventions to improve minority health and reduce health disparities. American Journal of Public Health 109(S1), S86-S93. DOI: 10.2105/AJPH.2018.304730 Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2018.304730
This article discusses the health disparities in disadvantaged communities, noting they are entrenched in the social and structural determinants of health of the community. The authors advise that these disparities cannot be tackled on an individual level but rather they need a multilevel intervention approach to identify the multifaceted causal factors and understand their vigorous relations within and across intervention levels. However, they add that multilevel interventions are complex and difficult to evaluate. The authors suggest creating a transdisciplinary team each member with skills needed to design and assess these interventions (Agurs-Collins, et al., 2019).
Curated Resources
Canadian Task Force on Preventative Health Care. (2018). Patient Tool - All Ages.  Breast Cancer Screening for Women Not at Increased Risk. Retrieved from https://canadiantaskforce.ca/wp-content/uploads/2019/01/CTFPHC_Breast_Cancer_1000_Person-Final_v10.pdf
This article reports on recommendations for mammogram screening by age for women not at significant risk for breast cancer. Women 40-49, who are not at risk, are conditionally recommended not to have screening by mammography due to the harms (overdiagnosis and false positives) outweighing the benefits. Women 50-69, and 70-74, who are not at risk, are conditionally recommended to screen with mammography every two to three years because the benefits outweigh the harms (Canadian Task Force on Preventative Health Care, 2018).
Curated Resources
Cancer Statistics Advisory Committee. (2007). Canadian Cancer Statistics 2007. Toronto, ON: Canadian Cancer Society; 2007. Available at: cancer.ca/Canadian-Cancer-Statistics-2018-EN (accessed [date]). Retrieved from http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2007-EN.pdf?la=en
This paper is an annual collaboration of the Canadian Cancer Society, the National Cancer Institute of Canada, Statistics Canada, Provincial/Territorial Cancer Registries and the Public Health Agency of Canada. Its purpose is to inform health professionals, researchers and policy makers on incidence and mortality of all types of cancers by age, sex, and province or territory. Its information and statistical data is also available to educators, the media and the general public (Cancer Statistics Advisory Committee, 2007).
Curated Resources
Hamm, N.C., Pelletier, L., Ellison, J., Lana Tennenhouse, L., Kim Reimer, K., Paterson, J.M., Puchtinger, R., Bartholomew, S., Phillips, K. A., & Lix, L. M. (2019). Original quantitative research – Trends in chronic disease incidence rates from the Canadian Chronic Disease Surveillance System. https://doi.org/10.24095/hpcdp.39.6/7.02
This Canadian Government study follows the incidence of chronic diseases throughout Canada, using data from the Canadian Chronic Disease Surveillance System (CCDSS). The study found that age-standardized chronic disease prevalence, the total number of disease cases, has been increasing over time possibly due to population aging, growth of the Canadian population or individuals living longer with the disease. Age-standardized incidence though, the number of new cases, appears to be decreasing for asthma, chronic obstructive pulmonary disease, hypertension, ischemic heart disease, and stroke, but not for diabetes (Hamm, et al., 2019).
Curated Resources
Ahmed, S., & Shahid, R. K. (2012). Disparity in cancer care: a Canadian perspective. Current Oncology, 19(6). Retrieved from https://current-oncology.com/index.php/oncology/article/view/1177/1066
This article discusses inequities in cancer care in socioeconomically disadvantaged groups and under-served communities in Canada. The authors note that these disparities undermine Canadian values, weaken the healthcare system and harm Canadian society as a whole. They examine the causes of the disparities and suggest action strategies to equalize the inequalities, such as, research coordinating prevention programs across organizations and health sectors, being culturally competent and sensitive, and involving patients in their own care (Ahmed & Shahid, 2012).
Curated Resources
Harkins, C., Shaw, R., Gillies, M., Sloan, H., MacIntyre, K., Scoular, A., Morrison, C., MacKay, F., Cunningham, H., Docherty, P., Paul MacIntyre, P., & Findlay, I. N. (2010). Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study. BMC Public Health, 10(391). Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-391
This paper discusses barriers to implementing preventative interventions in socioeconomically disadvantaged communities. It deals specifically with coronary heart disease but can be applied through many chronic diseases. It concludes that vulnerable populations are hard to reach, and a more individualized approach is necessary. To engage them in prevention programs, the authors suggest outreach programs where the target population is personally contacted. Face to face approaches were more successful in assuring participation in the programs (Harkins, et al., 2010).
Curated Resources
Ilaboya, D., Gibson, L., & Musoke, D. (2018). Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach. Globalization and Health, 14(9). Retrieved from https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0326-0
This article discusses barriers to early detection of breast cancer in low income countries. Barriers listed for the target population were; low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and public policy included health care burdens, lack of cancer policies and inadequate primary health care. Structural barriers were poverty, distance from healthcare facilities and limited access to media (Ilaboya, Gibson, & Musoke, 2018).
Curated Resources
Joffe, M., Ayeni, O., Norris, S. A., McCormack, V. A., Ruff, P., Das, I., … Cubasch, H. (2018). Barriers to early presentation of breast cancer among women in Soweto, South Africa. PloS one, 13(2), e0192071. doi:10.1371/journal.pone.0192071 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796726/
This article speaks about the barriers to early diagnosis of breast cancer in socially disadvantaged women. The authors note that geographical isolation, insufficient financial resources, the women’s cultural and religious beliefs in consulting community healers, and scarce healthcare facilities with unsatisfactorily trained healthcare professionals in cancer care are barriers to the administration of prompt care. As well, there are few intervention strategies for prevention and awareness (Joffe, et al., 2018).
Curated resources
The Community Preventive Services Task Force (CPSTF). (n. d.). Cancer screening: Reducing structural barriers for clients – breast cancer. The Community Guide. Retrieved from https://www.thecommunityguide.org/findings/cancer-screening-reducing-structural-barriers-clients-breast-cancer
This article lists various strategies for reducing structural barriers to breast cancer intervention. Suggestions include reducing the distance to care facilities by providing services in non-clinical settings, extending or changing the operational times of the facilities to better meet the needs of the population, simplifying administrative procedures and sending the target population reminders for programs and appointments to help facilitate compliance (The Community Preventive Services Task Force (CPSTF)., n. d.).
Curated Resources
Derfel, A. (2019, March 18). Hospital (in)security: Anatomy of an attack at Montreal General. Montreal Gazette. Retrieved from https://montrealgazette.com/news/local-news/hospital-insecurity-anatomy-of-a-nurse-attack-at-montreal-general
This article by a Montreal newspaper describes the near strangulation of a nurse in a closed psychiatric unit of the Montreal General Hospital emergency room, and the events that led to the violent incident. Budget cuts are partially held responsible, invoking staff cut backs that led the nurse to be without security and the customary second nurse in the isolated area and vulnerable to the attack (Derfel, 2019).
Curated Resources
Derfel, A. (2018, June 20). Hospital (in)security: New safety concerns arise at Montreal General. Montreal Gazette. Retrieved from https://montrealgazette.com/news/local-news/hospital-insecurity-new-safety-concerns-arise-at-montreal-general
This article by a reporter of the Montreal Gazette writes about operation budget cuts at the Montreal General Hospital which were forced upon it by the Quebec health ministry. These cuts in turn caused staff shortages which left a nurse in a locked psychiatric unit without support from security and a customary second nurse and made her susceptible to a violent attack by a patient (Derfel, 2018).
Curated Resources
Montreal General Hospital upgrades short-term psychiatric care, (2015, September 15). CBC News. Retrieved from https://www.cbc.ca/news/canada/montreal/montreal-general-hospital-psychiatry-1.3229306
This article in the Montreal Gazette writes about the addition of a secure psychiatric unit as part of the Montreal General Hospital emergency room (ER). The unit is at a distance from the main ER so that patients can have an area away from the general population with a calmer and quieter atmosphere. The unit is down a corridor with locked doors for security and confidentiality reasons (Montreal General Hospital upgrades short-term psychiatric care, 2015).
Curated Resources
Bourla, A. (2018, January 19). 5 key trends for the future of healthcare. World Economic Forum. Retrieved from https://www.weforum.org/agenda/2018/01/this-is-what-the-future-of-healthcare-looks-like/
An article about innovations and new technologies in healthcare. Trending are; immune-oncology (new immunotherapy for cancer), gene therapy (replacing defective genes or adding non-existent ones), personalized medicine (incorporating each patient’s individual needs, genetics and lifestyle), artificial intelligence (AI) (computer technology that can speed up analysis of important data), and wearable digital devices (devices that can capture important data from the wearer and enable him to participate in his own care (Bourla, 2018).
Curated Resources
Zamboni, A. (2018, January 12). Individualized patient care: A simple concept that is difficult to get right. Studer Group. Retrieved from https://www.studergroup.com/resources/articles-and-industry-updates/insights/january-2018/individualized-patient-care-done-right
An article that promotes the involvement of the patient in his own care. Individualized patient care asks patients what is important to them and considers their concerns, thoughts and beliefs when making decisions and providing care. This care strategy reduces patient anxiety, promotes patient satisfaction and encourages collaboration, all which impact on care outcomes (Zamboni, 2018).