Patient-reported outcomes and experiences assessment in women with breast cancer: Portuguese case study

In 2020, female breast cancer was the most commonly diagnosed cancer worldwide, representing the type of cancer with the highest incidence among women and the second most common cause of cancer death among women in all OECD countries. The conventional measures addressing the burden of breast cancer by measuring mortality, incidence, and survival do not entirely reflect the quality of life and patients' experience when receiving breast cancer care. The main objective of this study is to capture patient-reported outcomes and experiences in women with breast cancer in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 378 women with breast cancer, with the age distribution being 19.8% aged 15 to 49 years and 80.2% aged 50 years and over. The data collection procedure and analysis followed the "OECD Breast Cancer Patient Reported Outcomes Working Group" protocol, allowing subsequent comparability with data from other OECD member countries. Most women were satisfied with the treatment outcome regarding the shape of their lumpectomy breasts when wearing a bra (96.1%) and with the equal size of both breasts (78.3%). Findings on the WHO QOL-BREF showed that women manifest a lower score in well-being when compared with the general population or populations living with chronic diseases. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in breast cancer services in Portugal. Measuring PROMs and PREMs from Portuguese women receiving breast cancer care provides insightful evidence of the quality and value of cancer care.info:eu-repo/semantics/publishedVersio

We're making individuals more "health literate" but what about communities?

International audienceHealth literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. So much so that HL is now ranked as a determinant of population health. A central critic of HL intervention is its over emphasis on individual level factors something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH.Our objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH.We conducted a scoping review on PubMed looking for review papers, published between 2013-2018 in English and French. The reference lists of the papers were also searched to find other relevant articles. The WHO website was also consulted. The most cited definitions were analysed against two main dimensions (i.e. locus of change of HL strategies and foreseen outcome of HL improvements).We identified 419 articles. Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement stayed focused on intra individual factors. It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic.We conclude by drawing attention on the research gap in addressing the upstream SDoH through HL actions. We propose some elements of definition of HL reflecting the need for interventions to build capacities for collective action on the SDoH and develop measurements at the community level

Health Literacy: From a Property of Individuals to One of Communities

International audienceHealth literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. A central critic of HL intervention is its overemphasis on individual level factors, something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH. The objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH. We conducted a scoping review on PubMed looking for review papers published between 2013–2018 in English and French. Definitions of HL were analysed against two main dimensions (i.e., locus of change of HL strategies and foreseen outcome of HL improvements). Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement do not go beyond intra individual factors (knowledge, skills, etc.). It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic. We conclude by suggesting a new definition of HL and by drawing attention to the research gap in addressing the upstream SDoH through HL actions

Attitudes toward the elderly among young family physicians in Turkey

Introduction: General practitioners'(GPs) role is important as they are easily accessible especially for elderly. Young GPs need to improve their attitudes toward the elderly so that they can be a part of solution for health problems of elderly in the future. The aim of this study is to determine attitudes of young GPs toward elderly by the University of California at Los Angeles Geriatrics Attitude Scale (UCLA-GAS). Methods: It is a cross-sectional study performed with questionnaires including UCLA-GAS. The study population was 260 young doctors (GP residents and GPs in their first 5 years after qualification). Statistical evaluation of the data included percentage, mean, and Kolmogorov–Smirnov test and analysis of variance test. Results: Of the participants, 58.1% (n = 151) were women, 35.4% (n = 94) of them were GPs, and the remaining were GP residents. The mean age was 31.30 ± 5.40 years (range = 24–55 years). The mean score of UCLA-GAS was 46.85 ± 5.63 (range = 30–61). Participants ≤30 years of age had significantly higher scores (47.70 ± 5.99) than age above 30 years (45.68 ± 4.89) (P = 0.003). There was no statistically significant difference between GP residents and GPs (P = 0.989) and between participants who had rotation in elderly healthcare service (n = 63) or not (n = 197) (P = 0.383). However, as the duration of work increased, the score of UCLA-GAS decreased significantly (r = −0.216, P < 0.001). Conclusion: Young doctors who were interested in elderly showed more positive attitude as expected. However, the ones who were older and worked longer had less positive attitude. It seems important to understand and prevent this unfavourable attitude with formal education system about elderly healthcare during residency