Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment

Patients with cancer have complex care requirements that may result in an emergency department (ED) visit. In this retrospective cohort study, Ontario health databases were used to identify 42,820 qualifying patients who received chemotherapy or radiation in the 30-days prior to a cancer-related ED visit. Using multivariable models and propensity score matching, odds of hospitalization were lower in patients treated at alternative EDs compared to original EDs, but there was no difference in mortality, return ED visits or CT imaging. For patients seen at an alternative general hospital, the adjusted odds of hospitalization were again lower when compared to patients seen at original hospitals/cancer centres, but 30-day mortality and return ED visits were higher and CT imaging was lower. The results of this study suggest that the cancer expertise of an institution, rather than continuity of care, may be an important predictor of outcomes following emergency treatment of cancer patients.M.Sc.2019-07-10 00:00:0

Gender differences in motivations and perceived effects of Mind-Body Therapy (MBT) practice and views on integrative cardiac rehabilitation among acute coronary syndrome patients: Why do women use MBT?

Background: Over one-third of cardiac patients practice Mind-Body Therapy (MBT), particularly women. Considering women are less likely to engage in conventional physical activity, few studies have examined why MBT is well-accepted by women. Objectives: To qualitatively explore gender differences in the motivations for, and perceived effects of MBT, and the inter-relationships among alternative and conventional physical activities and secondary prevention programs. Methods: A random subsample of 16 participants (8 female) who reported practicing MBT in a larger study of 661 cardiac patients was interviewed until theme saturation was achieved. Audiotapes were transcribed and coded based on interpretive-descriptive technique within Nvivo-7 software. An audit trail and second coder were utilized to ensure the transparency and validity of results. After main themes emerged, the data were split by gender to identify differences for each theme. Results: Five themes emerged: (1) promotes positive well-being, (2) physical health benefits, (3) intrinsic and extrinsic motivations, (4) proactive health orientation, and (5) MBT as a preferred complementary and/or alternative physical activity. Men more often expressed preference for MBT for increased positive mood and cardiac-specific benefits, whereas women emphasized stress reduction, increasing self-efficacy, and physical activity, and were eager to see MBT offered in cardiac rehabilitation (CR). Conclusions: Both male and female users perceived substantial psychosocial and physical benefits of MBT practice. MBT addresses some of women's common barriers to CR.Canadian Health Services Research Foundation Ontario Ministry of Health and Long-Term Care The Canadian Institutes of Health Research & Heart and Stroke Foundation of CanadaCanadian Health Services Research Foundation Ontario Ministry of Health and Long-Term Care The Canadian Institutes of Health Research & Heart and Stroke Foundation of Canad

Access to cardiac rehabilitation among South Asian patients by referral method: A qualitative study

OBJECTIVES: South Asians (SA) suffer an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, SA are among the least likely to participate. ‘Automatic’ referral increases CR utilization and may reduce access inequalities. METHODS: This study qualitatively explored whether CR referral knowledge/access varied by referral method among SA patients. Participants were SA cardiac patients from Ontario hospitals. Each hospital refers to CR through one of four methods: automatically through paper or electronically; through discussion with allied health professionals (liaison referral); or through usual referral at physician discretion. Data was collected via interviews and analyzed using Interpretive-descriptive analysis. RESULTS: Four themes emerged: 1) importance of pre-discharge CR discussions with health care providers; 2) limited knowledge of CR; 3) ease of referral process as facilitator of CR attendance; 4) participants’ need for personal autonomy over decision to attend CR. CONCLUSION: Liaison referral was perceived to be the most suitable method of referral for participants. It facilitated communication between patients and providers, ensuring improved CR understanding. Automatic referral may be less suited for this population, due to reduced patient-provider communication

A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients

Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis, and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores, and recurrent events in CAD patients. One thousand two hundred and sixty eight CAD outpatients of 97 cardiologists were surveyed at two points. Recurrent events or hospitalization in the intervening 9 months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed, to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and investigate treatments is needed

Consistency of triage scores by presenting complaint pre- and post-implementation of a real-time electronic triage decision support tool

eCTAS is a real-time electronic decision-support tool designed to standardize the application of the Canadian Triage and Acuity Scale (CTAS). This study addresses the variability of CTAS score distributions across institutions pre- and post-eCTAS implementation

Differences in social support and illness perceptions among South Asian and Caucasian patients with coronary artery disease

Objective: Social support and illness perceptions may affect recovery from a cardiac event or procedure. Previous research found cardiac patients of South Asian origin have lower levels of social support and may perceive different causes of their condition. The purpose of this study was to quantitatively investigate differences in social support and illness perceptions between Caucasian and South Asian coronary artery disease (CAD) patients. Methods: 562 CAD inpatients (53 [9%] South Asian) were recruited from two hospitals. MOS social support scale and Illness Perception Questionnaire were administered to examine ethnocultural differences in total social support and subscales, and in illness perceptions subscales including causes of illness. Results: South Asian participants had significantly lower levels of tangible (p=.001) and emotional/informational support (p<.001) compared to Caucasian participants. South Asians were less likely than Caucasians to believe they have personal control over their illness (p<.001). Trends were observed with South Asian participants being more likely to attribute their condition to stress/worry (p=.04) and poor medical care in the past (p=.02), and less likely to attribute their illness to aging (p=.03) compared to Caucasian participants. Conclusions: Lower levels of social support among South Asians in Canada may have negative effects on recovery and prognosis. Our results support qualitative findings suggesting South Asians perceive their illness to be a result of fate and may be related to stress. Future studies should investigate interventions targeted at modifying illness perceptions among this group in an attempt to improve risk-reducing behaviour and secondary prevention use