A Qualitative Exploration of how Canadian Informal Caregivers in Medical Tourism use Experiential Resources to Cope with Providing Transnational Care

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what  has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences  of informal caregivers in medical tourism to learn more about the lived experiences or ‘experiential  resources’ they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers’ well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants’ perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we  can more effectively identify supportive interventions

Ethics of Care in Medical Tourism: Informal Caregivers\u27 Narratives of Responsibility, Vulnerability and Mutuality

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists

Exploring Informal Caregivers’ Roles in Medical Tourism through Qualitative Data Triangulation

When Canadian medical tourists go abroad, they are often accompanied by friends and family, referred to as caregiver-companions, who provide informal care. These individuals play a role in patient decision-making and are stakeholders in medical tourism, yet little is known about their participation in this consumer health practice. To examine the roles that Canadian caregiver-companions play while accompanying medical tourists abroad, and to identify how multi-perspective qualitative data can augment our understanding of these roles, primary and secondary analysis was undertaken on datasets generated from multiple qualitative studies: semi-structured interviews with medical tourists, caregiver-companions, and international patient coordinators, and a survey with medical tourism facilitators. The findings from the triangulated analysis of these qualitative datasets serve to better understand the multiple, overlapping perspectives of different stakeholders in medical tourism. Results show that medical tourism caregivers act as companions, providing physical and emotional care; navigators, providing logistical assistance; and knowledge brokers, participating in decision-making and information exchange between medical tourists and professionals. Using data triangulation to examine the narratives of multiple stakeholders confirmed, altered, and augmented our knowledge of caregiver-companion roles. The unique perspectives offered by each participant group augment our understanding of caregiver roles and the practice of medical tourism

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing

“The Major Forces that Need to Back Medical Tourism Were ... in Alignment”: Championing Development of Barbados’s Medical Tourism Sector

Governments around the world have expressed interest in developing local medical tourism sectors, framing the industry as an opportunity for economic growth and health system improvement. This article addresses questions about how the desire to develop a medical tourism sector in a country emerges and which stakeholders are involved in both creating momentum and informing its progress. Presenting a thematic analysis of 19 key informant interviews conducted with domestic and inter-national stakeholders in Barbados’s medical tourism sector in 2011, we examine the roles that “actors” and “champions” at home and abroad have played in the sector’s development. Physicians and the Barbadian government, along with international investors, the Medical Tourism Association, and development agencies, have promoted the industry, while actors such as medical tourists and international hospital accreditation companies are passively framing the terms of how medical tourism is unfolding in Barbados. Within this context, we seek to better understand the roles and relationships of various actors and champions implicated in the development of medical tourism in order to provide a more nuanced understanding of how the sector is emerging in Barbados and elsewhere and how its development might impact equitable health system development.&nbsp

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

Background Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. Conclusions This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.ECU ALS PLOS Institutional Account Progra

Regulation of surfactant protein D in the rodent prostate

<p>Abstract</p> <p>Background</p> <p>Surfactant protein D (SP-D) is an innate immune protein that is present in mucosal lined surfaces throughout the human body, including the male reproductive tract. In the present study, we characterized the regulation of SP-D expression in the mouse and rat prostate.</p> <p>Methods</p> <p>Real time reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining were used to characterize SP-D mRNA and protein in the mouse male reproductive tract. In order to evaluate the effects of testosterone on SP-D gene expression, we measured SP-D mRNA levels via real time RT-PCR in prostates from sham-castrated mice and castrated mice. In addition, we used a rat prostatitis model in which Escherichia coli was injected into the prostate in vivo to determine if infection influences SP-D protein levels in the prostate.</p> <p>Results</p> <p>We found that SP-D mRNA and protein are present throughout the mouse male reproductive tract, including in the prostate. We determined that castration increases prostate SP-D mRNA levels (~7 fold) when compared to levels in sham-castrated animals. Finally, we demonstrated that infection in the prostate results in a significant increase in SP-D content 24 and 48 hours post-infection.</p> <p>Conclusion</p> <p>Our results suggest that infection and androgens regulate SP-D in the prostate.</p

Differences in receipt of multimodality therapy by race,insurance status, and socioeconomic disadvantage in patientswith resected pancreatic cancer

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Background and Methods:Racial and socioeconomic disparities in receipt ofadjuvant chemotherapy affect patients with pancreatic cancer. However, differencesin receipt of neoadjuvant chemotherapy among patients undergoing resection arenot well�understood. A retrospective cross�sectional cohort of patients withresected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified fromthe National Cancer Database (2014–2017). Outcomes included receipt ofneoadjuvant versus adjuvant chemotherapy, or receipt of either, defined asmultimodality therapy and were assessed by univariate and multivariate analysis.Results:Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624(49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received nochemotherapy. On multivariable analysis, Black patients had lower odds ofneoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI:0.67–0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95%CI: 0.77–1.03). Patients with Medicaid or no insurance, low educational attainment,or low median income had significantly lower odds of receiving neoadjuvantchemotherapy or multimodality therapy.Conclusions:Racial and socioeconomic disparities persist in receipt of neoadjuvantand multimodality therapy in patients with resected pancreatic adenocarcinoma.Discussion:Policy and interventional implementations are needed to bridge thecontinued socioeconomic and racial disparity gap in pancreatic cancer care.ECU/Wiley Open Access Publishing Agreemen