Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic.

PURPOSE: In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS: The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS: Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION: Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.

Experience of loneliness and depression due to spousal separation by long-term care residents and their spouses: a qualitative systematic review.

OBJECTIVE: The objective of this review was to describe the experiences of loneliness and/or depression for residents and their spouses who are separated by long-term care placement. INTRODUCTION: Loneliness and depression have a pernicious influence on the overall health and well-being of older adults. Older adults' mental health is significantly affected by social relationships, including those between spouses. However, research pertaining to the experience or effect of spousal separation on long-term care residents and community-dwelling spouses' feelings of loneliness and/or depression is limited. INCLUSION CRITERIA: This systematic review included studies that recruited community-dwelling spouses and long-term care residents over 50 years of age with living spouses from whom they are separated due to long-term care placement. Studies on the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in long-term care were included in this review. METHODS: Ovid MEDLINE(R) was used for the initial search. A full search strategy was developed for Ovid MEDLINE(R), CINAHL (EBSCOhost), Embase (Ovid), and PsycINFO (Ovid). The review was conducted using the JBI approach, with 2 independent reviewers performing study selection, critical appraisal, data extraction, assessment of confidence, and data synthesis. RESULTS: Eleven papers were included in this systematic review. Four synthesized findings were extracted from 10 categories and 42 findings: i) Loneliness and depression result from a lack of physical and social connection for separated long-term care residents and community-dwelling spouses; ii) Community-dwelling spouses feel unprepared and upset with spousal separation due to a lack of psychological support; iii) Behavioral strategies can prevent community-dwelling spouses and long-term care residents from developing loneliness and/or depression; and 4) Community-dwelling spouses have differing abilities to adapt and cope with feelings of loneliness and/or depression. CONCLUSION: This review provides a comprehensive synthesis of the feelings of loneliness and/or depression spouses who are separated due to long-term care admission experience. This review has demonstrated that there is a lack of literature inclusive of the voices and perspectives of all spouses affected by spousal separation in long-term care. The limitations of this review include the small number of included studies and the range of quality of included studies. Recommendations include additional research on the lived experience of spousal separation from the perspectives of long-term care residents and their community-dwelling spouses. Further, additional psychological support is needed for separated spouses guided by the suggestions and experiences of long-term care residents and their community-dwelling spouses. REVIEW REGISTRATION: PROSPERO CRD42022333014.

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review.

Diabetes mellitus is a chronic metabolic health condition affecting millions globally. Diabetes is a growing concern among aging societies, with its prevalence increasing among those aged 65 and above. Enabling disease self-management via relevant education is part of high-quality care to improve health outcomes and minimize complications for individuals living with diabetes. Successful diabetes self-management education (DSME) programs usually require tailoring for the intended audience; however, there is limited literature about the preferences of older persons in Western countries concerning DSME. As such, a broad overview of DSME for older persons was an identified need. To map the available evidence on DSME for persons aged 65 years and older in Western countries, the JBI methodology for conducting and reporting scoping reviews was used. In this scoping review, we considered all studies about DSME for older persons with T1D and T2D in Western countries where lifestyles, risks, prevention, treatment of diabetes, and approaches to self-management and DSME are similar (e.g., North America, Western and Northern Europe and Australasia). Systematic keyword and subject heading searches were conducted in 10 databases (e.g., MEDLINE, JBI EBP) to identify relevant English language papers published from 2000 to 2022. Titles and abstracts were screened to select eligible papers for full-text reading. Full-text screening was done by four independent reviewers to select studies for the final analysis. The review identified 2,397 studies, of which 1,250 full texts were screened for eligibility. Of the final 44 papers included in the review, only one included participants' understanding of DSME. The education programs differed in their context, design, delivery mode, theoretical underpinnings, and duration. Type of research designs, outcome measures used to determine the effectiveness of DSME, and knowledge gaps were also detailed. Overall, most interventions were effective and improved clinical and behavioural outcomes. Many of the programs led to improvements in clinical outcomes and participants' quality of life; however, the content needs to be adapted to older persons according to their culture, different degrees of health literacy, preference of education (e.g., individualized or group), preference of setting, degree of frailty and independence, and comorbidities. Few studies included the voices of older persons in the design, implementation, and evaluation of DSME programs. Such experiential knowledge is vital in developing educational programs to ensure alignment with this population's preferred learning styles, literacy levels, culture, and needs-such an approach could manifest more substantive, sustained results.

Improving Access and Timeliness of Early Palliative Care Specialist Assessment for Patients With Advanced Lung Cancer in a Rapid Assessment Clinic.

Background: Integrating palliative care in the management of patients with lung cancer improves quality of life, patient satisfaction, and overall survival. However, few patients receive timely palliative care consultation. The Lung Diagnostic Assessment Program (LDAP) in Southeastern Ontario is a multidisciplinary rapid assessment clinic that expedites the diagnosis and management of patients with suspected lung cancer. Objectives: We sought to increase the percentage of LDAP patients with stage IV lung cancer receiving palliative care consultation within three months of diagnosis. Design: We integrated a palliative care specialist in LDAP to facilitate in-person, same-visit consultation for patients with a new lung cancer diagnosis. Setting/Subjects: Five hundred fifty patients in a Canadian academic center (154 initial baseline, 104 COVID baseline, 292 post-palliative care integration). Measurements: Baseline data were established using retrospective chart review (February-June 2020 and December 2020-March 2021 due to COVID-19 pandemic). Data were collected prospectively to assess improvement (March-August 2021). Statistical Process Control charts assessed for special cause variation; chi-square tests assessed for differences between groups. Results: The percentage of patients with stage IV lung cancer seen by palliative care within three months increased from 21.8% (12/55) during early-COVID baseline to 49.2% (32/65) after palliative care integration (p < 0.006). Palliative care integration in LDAP reduced mean time from referral to consultation from 24.8 to 12.3 days, including same-day consultation for 15/32 (46.8%) patients with stage IV disease. Conclusions: Integrating palliative care specialists into LDAP improved the timeliness of palliative care assessment for patients with stage IV lung cancer.

Experience of loneliness and depression due to spousal separation in long-term care residents and their spouses: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to describe the experience of loneliness and/or depression due to spousal separation when one or both spouses are admitted into a long-term care facility. INTRODUCTION: Loneliness and depression are important concerns for the health and well-being of older adults separated from their spouses due to long-term care placement. Social relationships, specifically spousal relationships, have a significant impact on the mental health of older adults. However, there is limited research on the experience or effect of spousal separation on long-term care residents' and their spouses' experience of loneliness and/or depression. INCLUSION CRITERIA: This review will include long-term care residents and their spouses who are over the age of 50 and have a spouse they are separated from due to long-term care placement. Studies will be included in this review if they explore the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in a long-term care facility. METHODS: This review will be conducted in line with the JBI methodology for systematic reviews of qualitative evidence. MEDLINE was used for the initial search. A full search strategy was then developed for MEDLINE, CINAHL, Embase, and PsycINFO. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be used. Two reviewers will pilot test the screening criteria and data extraction protocol. REVIEW REGISTRATION: PROSPERO CRD42022333014.

"I Could Have Stood a Little More Education Rather than Just: 'Hey, you're Diabetic Man, Make the Best out of It'": Revisioning Diabetes Self-Management Education for Older Adults.

Objectives: Providing diabetes self-management education (DSME) in an evidence-based format that is accessible and tailored to the population needs is crucial for individuals living with diabetes mellitus. Our qualitative study explores the experiences of older adults living with diabetes while residing in a rural setting. Methods: Adults aged 65 or older and residing in a rural area of Ontario completed a photovoice activity and semi-structured interviews to illustrate their experience of living with diabetes and accessing DSME. Results: Fourteen participants (11 males; mean age = 74 years) completed the photovoice activity and interview. Four main themes were identified pertaining to learning about diabetes education, the depth and breadth of learning, applying knowledge to daily life, and engaging older adults in DSME. Discussion: Diabetes self-management education should account for older adults' preferences in learning about diabetes and self-management to promote access to evidence-based information, bolster knowledge and self-management efficacy, and improve disease control.

Diabetes self-management education for older adults in Western countries: a scoping review protocol.

OBJECTIVE: This scoping review will map the available evidence on diabetes self-management education programs for older adults in Western countries. INTRODUCTION: Self-management and education are crucial for controlling diabetes and its associated complications. The successful uptake of diabetes self-management education programs is not straightforward, and little is known about diabetes programs for older adults. Within this context, a broad overview of diabetes self-management education for older adults, considering all types of related evidence, is needed. INCLUSION CRITERIA: All studies in English concerning diabetes self-management education for older adults (aged 65 years and older) living with type 1 or 2 diabetes will be included. This review will not be specific to gender, sex, ethnicity, frailty, or other demographic variables. The review will be restricted to Western countries (North America, Western and Northern Europe, and Australasia), where approaches to diabetes self-management education will be similar. Studies including older adults with or without diabetes will not be considered unless they provide separate analyses for the 2 cohorts. METHODS: This scoping review will follow the JBI methodology for scoping reviews. We will conduct searches of electronic databases, including CINAHL, MEDLINE, and PubMed, from January 1, 2000, to the present to capture eligible articles. The review will consider all study designs, including quantitative, qualitative, mixed methods designs, as well as text and opinion papers, and systematic reviews that meet the inclusion criteria. After duplicates are removed, titles and abstracts will be screened independently by 2 reviewers, and the full texts will be reviewed. The screening criteria and data extraction protocol will be pilot-tested by the research team. The results will be summarized in tables accompanied by narrative text.

Barriers and facilitators to education experienced by students with disabilities in low- and middle-income African countries: a systematic review of qualitative evidence.

OBJECTIVE: This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. INTRODUCTION: Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. INCLUSION CRITERIA: This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. METHODS: An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. RESULTS: Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. CONCLUSIONS: This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137951.