Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review.

BACKGROUND: Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS: A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS: Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION: Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.

Occupational and Financial Setbacks in Caregivers of People with Colorectal Cancer: Considerations for Caregiver-Reported Outcomes.

Family caregivers of patients with cancer provide substantial physical, emotional, and functional care throughout the cancer trajectory. While caregiving can create employment and financial challenges, there is insufficient evidence to inform the development of caregiver-reported outcomes (CROs) that assess these experiences. The study purpose was to describe the occupational and financial consequences that were important to family caregivers of a patient with colorectal cancer (CRC) in the context of public health care, which represent potential considerations for CROs. In this qualitative Interpretive Description study, we analyzed interview data from 78 participants (25 caregivers, 37 patients, and 16 healthcare providers). Our findings point to temporary and long-term occupational and financial setbacks in the context of CRC. Caregiving for a person with CRC involved managing occupational implications, including (1) revamping employment arrangements, and (2) juggling work, family, and household demands. Caregiver financial struggles included (1) responding to financial demands at various stages of life, and (2) facing the spectre of lifelong expenses. Study findings offer novel insight into the cancer-related occupational and financial challenges facing caregivers, despite government-funded universal health care. Further research is warranted to develop CRO measures that assess the multifaceted nature of these challenges.

To share or not to share: communication of caregiver-reported outcomes when a patient has colorectal cancer.

BACKGROUND: The importance of patient-centered measurement in cancer care has led to recognition of the potential for caregiver-reported outcomes to improve caregiver, patient and healthcare system outcomes. Yet, there is limited evidence to inform caregiver-reported outcome implementation. Our purpose was to generate evidence to inform the meaningful and constructive integration of caregiver-reported outcomes into cancer care to benefit caregivers, including exploration of the question of the extent to which these assessments should be shared with patients. We focused on caregivers of patients with colorectal cancer (CRC) because CRC is common, and associated caregiving can be complex. RESULTS: From our Interpretive Description analysis of qualitative interview data from 78 participants (25 caregivers, 37 patients, and 16 healthcare providers [HCPs]), we identified contrasting perspectives about the sharing of caregiver-reported outcome assessments with patients with CRC. Those who preferred open communication with both the patient and caregiver present considered this essential for supporting the caregiver. The participants who preferred private communication without the patient, cited concern about caregiver- and patient-burden and guilt. Recognizing these perspectives, HCPs described strategies used to navigate sensitivities inherent in preferences for open versus private communication. CONCLUSIONS: The integration of caregiver-reported outcomes into cancer care will require careful consideration of caregiver and patient preferences regarding the communication of caregiver assessments to prevent additional burden.

Educational attainment predicts negative perceptions women have of their own climate change knowledge.

Education may encourage personal and collective responses to climate change, but climate education has proven surprisingly difficult and complex. Self-perception of knowledge and intelligence represent one factor that may impact willingness to learn about climate change. We explored this possibility with a case study in Raleigh, North Carolina in 2015 (n = 200). Our goal was to test how gender and ethnicity influenced perceptions people had of their own climate change knowledge. Survey respondents were asked how strongly they agreed with the statement "I feel knowledgeable about climate change" (1 = strongly disagree, and 5 = strongly agree). Our survey instrument also included demographic questions about race, age, income, gender, and education, as well as respondent's experience with natural disasters and drought. We observed an interaction between education and gender where women's self-perceived knowledge was higher than men among people with low levels of educational attainment, but was higher for men than women among people with high levels of educational attainment. In addition, minority respondents self-reported lower perceived climate change knowledge than white respondents, regardless of educational attainment. This study enhances our understanding of the gender gap in self-perceptions of climate knowledge by suggesting it is contingent on educational attainment. This could be the result of stereotype-threat experienced by women and minorities, and exacerbated by educational systems. Because people who question their knowledge are often more able to learn, particularly in ideologically charged contexts, highly educated women and minorities may be more successful learning about climate change than white men.

Beyond Impervious: Urban Land-Cover Pattern Variation and Implications for Watershed Management.

Impervious surfaces degrade urban water quality, but their over-coverage has not explained the persistent water quality variation observed among catchments with similar rates of imperviousness. Land-cover patterns likely explain much of this variation, although little is known about how they vary among watersheds. Our goal was to analyze a series of urban catchments within a range of impervious cover to evaluate how land-cover varies among them. We then highlight examples from the literature to explore the potential effects of land-cover pattern variability for urban watershed management. High-resolution (1 m(2)) land-cover data were used to quantify 23 land-cover pattern and stormwater infrastructure metrics within 32 catchments across the Triangle Region of North Carolina. These metrics were used to analyze variability in land-cover patterns among the study catchments. We used hierarchical clustering to organize the catchments into four groups, each with a distinct landscape pattern. Among these groups, the connectivity of combined land-cover patches accounted for 40 %, and the size and shape of lawns and buildings accounted for 20 %, of the overall variation in land-cover patterns among catchments. Storm water infrastructure metrics accounted for 8 % of the remaining variation. Our analysis demonstrates that land-cover patterns do vary among urban catchments, and that trees and grass (lawns) are divergent cover types in urban systems. The complex interactions among land-covers have several direct implications for the ongoing management of urban watersheds.