A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations.

Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction.

Widening the Lens on Needs Assessment: Identifying Profession-Specific and Interprofessional Learning Needs Across Professions in an Academic Health Sciences Institution.

Traditionally, education planning for the health professions is conducted in a reactive manner, with profession-specific learning opportunities being organized in response to educational issues arising or based upon speaker availability. Moreover, limited information exists to guide organizations on systematic approaches to planning and implementing large-scale interprofessional learning programs, despite clear evidence for benefits of team-based learning in the workplace. Our organizational approach to the learning needs assessment process was in need of updating to enhance pedagogical rigor and to proactively inform ongoing education planning with respect to both profession-specific and interprofessional learning needs. To address this, a novel mixed methods approach integrated within a quality improvement framework was developed to elicit participant engagement. The approach included use of a questionnaire, focus groups, and key stakeholder interviews. Ranking of learning priorities of respondents indicated that highest priority was placed on learning needs related to profession-specific clinical and technical skills. A number of distinct inter¬professional learning needs were identified through this novel needs assessment process, including a selection of clinical topics that were deemed to be well-suited for interprofessional learning forums. Utilization of a multi-method interprofessional approach to needs assessment thus enabled elicitation of more comprehensive results than could have been achieved through a traditional profession-specific needs assessment, and hence changing our ongoing approach to education planning at our organization.

Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? - National Survey.

PURPOSE: Clinical judgement may not be sufficient to detect relevant problems in older cancer patients. We investigated what Geriatric Assessment tools (GA) are used by Canadian radiation oncologists (CROs) to treat non-metastatic prostate cancer patients aged 80 years and older. METHODS: A 27-item cross-sectional survey was developed with input from a multidisciplinary team and distributed electronically to Genitourinary (GU) CROs via LimeSurvey. Survey contents included: demographics, treatment choice based on components of GA, and how GA tools are used in clinic. Descriptive statistics were used to analyze multiple-choice data, with Open-ended question being coded and analyzed for emerging themes. RESULTS: 154 GU CRO's were contacted, 44 responded (29%). Active surveillance was the choice of therapy in older low risk prostate cancer patients regardless of factors used in a GA assessment (97%). Results in intermediate and high-risk older prostate cancer patients were more heterogenous. Functional status and comorbidities were the most important factor in the decision-making-process (94%, 91%). Sixty-six percent of CROs did not use any GA tools; yet 77% felt comfortable to very comfortable treating older patients. Eighty-eight percent felt there were some to very few guidelines in helping them to treat older patients. Barriers to using GA included lack of knowledge, time, support, and resources. CONCLUSIONS: GAs are not commonly utilized by CROs. Majority of CROs felt comfortable treating older patients with prostate cancer, regardless of guidelines/evidence in this population. This may have negative implications on patient care. CROs are however open to referring patients for a formal GA.

Exploring attitudes of Canadian radiation oncologists, radiation therapists, physicists, and oncology nurses regarding interprofessional teaching and learning.

The purposes of this exploratory study were to investigate the attitudes of radiation oncology professionals regarding interprofessional (IP) teaching and interprofessional education (IPE), to identify the challenges faced by radiation oncologists who teach within an IP context, and to discover new strategies to aid professionals teaching IP students. A questionnaire was developed through the review of existing literature on IPE using Medline. The proposed group of questions was selected by educators from different professions actively involved in IPE. The final revised questionnaire consisted of three main domains assessing the understanding of IP concepts, attitudes toward IP teaching and learning environments, and attitudes toward health-care teams. An open-ended comment section was included. The questionnaire was administered to health-care professionals (physicists, radiation oncologists, and radiation therapists) nationally through SurveyMonkey® (electronic survey). A total of 220 respondents provided demographic information. Half of these respondents indicated that they previously received education relating to IPE. A high level of agreement was received for nearly all the questions. There were no significant statistical differences among the three different professional respondent groups for any question. Overall, most of the respondents demonstrated a good knowledge and understanding of IP concepts and advocated IP training and collaboration.

Understanding Radiation Therapists' Perceptions and Approach to Clinical Competence Assessment of Medical Radiation Sciences Students.

BACKGROUND: Within the academic clinical setting, radiation therapists are required to assess students' performance and competence as part of their clinical practice portfolio. Anecdotal feedback from the clinical setting identified challenges in assessment that emerged as a result of variation in who, how, and the context in which the assessment was being completed. A survey was distributed to gain insight into the current state of clinical competency assessment. METHODOLOGY: Radiation therapists (n = 75) from two affiliated clinical sites within an undergraduate program were surveyed. The online survey consisted of open and closed questions. The survey was divided into three principal themes on the assessment of clinical competence: (1) who completes the assessment, (2) how clinical competence is assessed, and (3) what measures are utilized in the assessment. The survey also captured the clinical experience and formal training in education and assessment of respondents. RESULTS: All respondents were aware that clinical teaching was part of their portfolio, but only 45 (60.0%) enjoyed teaching students, 41 (55.4%) rated themselves as very comfortable assessing competence, and 69 (93.2%) were aware of documentation and support on how to evaluate. All collaborate with team members and slightly less with the clinical educators. Sixty-four (86.5%) defined successful competence as sustainability over a defined period of time, measuring both clinical knowledge and application. CONCLUSIONS: Processes surrounding the assessment of clinical competence are congruent among all clinical teachers, supporting their reliability. Enhanced collaboration with clinical educators in both support and training will increase the validity of clinical assessment. In addition, to minimize variability in clinical assessment, the focus should be placed on training the assessors and not controlling the assessment process.

Pain Management Needs Assessment: A Survey of Radiation Therapists at a Large Academic Comprehensive Cancer Centre.

OBJECTIVE: To determine the knowledge of pain management among the radiation therapists (RTs) at the Odette Cancer Centre (OCC) to aid in the development of a formalized education strategy. METHODS: A needs assessment survey comprising eight topics pertaining to pain management was distributed to 130 RTs at the OCC. Survey topics were ranked using a 4-point Likert scale based on preference for further education, familiarity with the topic, and relevance to practice. RESULTS: RTs rated topics pertaining to the undertreatment, pathophysiology, assessment, diagnosis, and treatment of pain as the most relevant topics requiring further education. RTs were most unfamiliar with topics concerning opioids and addiction, but did not find a need for further education. They also felt that breakthrough cancer pain was the most significant topic for further education. CONCLUSION: Implementation of an educational intervention for RTs to more effectively and efficiently address pain management for their patient population is needed. Topics of most clinical relevance include: undertreatment of pain, pathophysiology of pain, assessment and diagnosis of acute and chronic pain as well as its treatment.