PUBLICATIONS

Abstract Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning <?CA$50,000/year. Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

Many medical services lack robust evidence of effectiveness and may therefore be considered "unnecessary" care. Proactively withdrawing resources from, or de-funding, such services and redirecting the savings to services that have proven effectiveness would enhance overall health system performance. Despite this, governments have been reluctant to discontinue funding of services once funding is in place. The focus of this study is to understand how the framing of an issue or problem influences government decision-making related to de-funding of medical services. To achieve this, a framework describing how problem frames, or explanatory naratives, influence government policy decisions was developed and applied to actual cases. The two cases selected were the Ontario government's decisions to de-fund the drug Oxycontin and blood glucose test strips used by patients with diabetes. A qualitative content analysis of public discourse (political debate and media coverage) surrounding these two resource withdrawal examples was conducted and described using the framework. In the framework, government decision-making is a partial reflection of the visibility of the policy issue and complexity of the causal story told within a problem frame. By applying this framework and considering these two key characteristics of problem frames, we can better understand, and possibly predict, the shape and timing of government policy decisions to withdraw resources from medical services.

Background: The use of information and communication technology (ICT) has tremendous potential to enhance communication among physicians, leading to improvements in service delivery. However, the protection of health information in digital/electronic format is an ongoing concern. Objective: The purpose of this study was to examine guidance for the protection of health information when using ICT from all 10 of Canada’s provincial regulatory colleges for physicians and to discuss the potential policy and service delivery implications. Method: A search of the regulatory college websites was conducted, followed by a document analysis (content and thematic). Results: The college website search identified 522 documents; 12 of these documents (from 8 of the 10 colleges) met the study criteria. These documents were notable for the considerable variation in the scope and detail of guidance provided across the colleges. Conclusion: While the federal–provincial division of powers in Canada enables different jurisdictional approaches to health service delivery and, thus, opportunities for policy learning, this governing structure may also contribute to a lack of incentive for collaboration, leading to an absence of standardised guidance for health information protection when using ICT. This, in turn, may result in unequal and inequitable protection of health information across the provinces. Therefore, a macro-level approach to policy development in this area may hold the greatest promise for enhancing the protection of health information and doing so in a more standardised manner in countries with federal systems of governance.

Abstract Background Midwifery students’ intention to stay in the profession can be influenced by how the interface of their work and personal life is affected by their clinical placement experience. The purpose of this study is to compare the intention to stay in the midwifery profession and its association with three work/personal life interface constructs among pre- and post-clinical placement midwifery students in Canada. The constructs investigated are work interference with personal life, personal life interference with work, and work/personal life enhancement. Methods Quantitative cross-sectional data were collected through two separate online surveys completed by pre- and post-clinical placement students. In total, 456 midwifery students attending six different midwifery education programs responded to the surveys. Results Compared to pre-clinical placement students, post-clinical placement students had significantly lower intention to stay in the profession. For pre-clinical placement students, higher personal life interference with work was significantly associated with lower intention to stay in the profession. For post-clinical placement students, higher work interference with personal life was associated with lower intention to stay in the profession. We did not find any significant relationships between work/personal life enhancement and intention to stay in the profession in pre- or post-clinical placement students. Conclusion Pre- and post-clinical placement students have different intentions to stay in the profession. For pre-clinical placement students, those who report that their personal lives highly interfere with work are less likely to want to stay in the midwifery profession. Post-clinical placement students reported that when working interfered with their personal lives they were less likely to want to stay in the profession. Our findings highlight the importance of offering students a realistic preview of the required commitment, workload, and personal involvement in the midwifery profession prior to applying or accepting a spot in a midwifery education program. Furthermore, facilitating the development of skills to better manage the expectations in midwifery work and personal lives might help with maintaining positive intentions to stay in the profession.

Abstract Background Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including ‘rationing’ and ‘disinvestment’, have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. The objectives of this study are to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or foundational terms, which includes a clear description of the unique characteristics of each. Methods This is a systematic qualitative synthesis of characteristics and terms found through a search of the academic and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising elements as antecedents, attributes or outcomes. Results Findings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes, are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To enhance precision, these terms were classified as either policy options or patient health outcomes and refined definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies, on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average, improved or no change in health benefits. Conclusion Agreement on the definition of various resource withdrawal terms and their key characteristics is required for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy dialogue and enhance the policy-making process for health systems.