Post-sternotomy movement strategies in adults: a scoping review.

AIMS: Post-sternotomy movement strategies for adults should be an evidence-informed approach and support a safe, independent return to daily activity. Recent new movement strategies have emerged. The aim of this scoping review was to identify and summarize the available evidence for post-sternotomy movement strategies in adults. METHODS AND RESULTS: The electronic databases searched included MEDLINE, Embase, Sport Discus, CINAHL, Academic Search Complete, the Cochrane Library, Scopus, and PEDro. The search did not have a date limit. After 2405 duplicates were removed, 2978 records were screened, and 12 were included; an additional 2 studies were identified through reference searching for a total of 14 included studies. A data extraction table was used, and the findings are summarized in a tabular and narrative form. Three post-sternotomy movement strategies were identified in the literature: sternal precautions (SP), modified SP, and Keep Your Move in the Tube (KYMITT™). The authors suggested that the practice of SP was based on expert opinion and not founded in evidence. However, the evidence from the identified articles suggested that new movement strategies are safe and allow patients to choose an increased level of activity that promotes improved functional status and confidence. CONCLUSION: More prospective cohort studies and multi-centred randomized control trials are needed; however, the current evidence suggests that modified SP and KYMITT™ are as safe as SP and can promote a patient-centred approach. REGISTRATION: University of Calgary's Digital Repository PRISM http://hdl.handle.net/1880/115439.

An Integrative Review of Patient Education During Inpatient Hematopoietic Stem Cell Transplantation.

PROBLEM IDENTIFICATION: Patients undergoing hematopoietic stem cell transplantation (HSCT) have significant learning needs that nurses must provide. The review question was "What teaching methods and strategies have been examined to deliver education to patients undergoing HSCT?" LITERATURE SEARCH: The review was conducted in November 2022 using the following databases: Scopus®, Embase®, MEDLINE®, CINAHL®, PsycINFO®, and ERIC. The search comprised two main concepts: HSCT and patient education. DATA EVALUATION: The search yielded 1,458 records after duplicates were removed, and 3 studies were included in this review. The studies were critically appraised using the Mixed Methods Appraisal Tool and deemed to be of moderate quality. SYNTHESIS: Problem-solving training was the teaching method used in all three studies. Satisfaction was noted among patients and those delivering the intervention. The effect of the training on information retention or application was not measured. IMPLICATIONS FOR PRACTICE: Additional research is needed to explore how to best educate patients undergoing HSCT while hospitalized. Structured teaching methods may have a sound theoretical basis and warrant additional investigation using more rigorous research methods.

Alignment Among Patient, Caregiver, and Health Care Provider Perspectives on Hemodialysis Vascular Access Decision-Making: A Qualitative Study.

Background: Updates to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access emphasize the "right access, in the right patient, at the right time, for the right reasons." Although this implies a collaborative approach, little is known about how patients, their caregivers, and health care providers engage in vascular access (VA) decision-making. Objective: To explore how the perspectives of patients receiving hemodialysis, their caregivers, and hemodialysis care team align and diverge in relation to VA selection. Design: Qualitative descriptive study. Setting: Five outpatient hemodialysis centers in Calgary, Alberta. Participants: Our purposive sample included 19 patients receiving maintenance hemodialysis, 2 caregivers, and 21 health care providers (7 hemodialysis nurses, 6 VA nurses, and 8 nephrologists). Methods: We conducted semi-structured interviews with consenting participants. Using an inductive thematic analysis approach, we coded transcripts in duplicate and characterized themes addressing our research objective. Results: While participants across roles shared some perspectives related to VA decision-making, we identified areas where views diverged. Areas of alignment included (1) optimizing patient preparedness-acknowledging decisional readiness and timing, and (2) value placed on trusting relationships with the kidney care team-respecting decisional autonomy with guidance. Perspectives diverged in the following aspects: (1) differing VA priorities and preferences-patients' emphasis on minimizing disruptions to normalcy contrasted with providers' preferences for fistulas and optimizing biomedical parameters of dialysis; (2) influence of personal and peer experience-patients preferred pragmatic, experiential knowledge, whereas providers emphasized informational credibility; and (3) endpoints for VA review-reassessment of VA decisions was prompted by access dissatisfaction for patients and a medical imperative to achieve a functioning access for health care providers. Limitations: Participation was limited to individuals comfortable communicating in English and from urban, in-center hemodialysis units. Few informal caregivers of people receiving hemodialysis and younger patients participated in this study. Conclusions: Although patients, caregivers, and healthcare providers share perspectives on important aspects of VA decisions, conflicting priorities and preferences may impact the decisional outcome. Findings highlight opportunities to bridge knowledge and readiness gaps and integrate shared decision-making in the VA selection process.

Contexte: Les mises à jour des lignes directrices de pratiques cliniques en matière d'accès vasculaire de la KDOQI (Kidney Disease Outcomes Quality Initiative) insistent sur la création « du bon accès, à la bonne personne, au bon moment et pour les bonnes raisons ¼. Ces recommandations sous-entendent une approche collaborative, mais la façon dont les patients, leurs soignants et les prestataires de soins de santé participent à la prise de décision sur l'accès vasculaire (AV) demeure mal connue. Objectif: Explorer les accords et les divergences dans les points de vue des patients sous hémodialyse, leurs soignants et leur équipe de soins relativement à la sélection de l'AV. Conception: Étude qualitative et descriptive. Cadre: Cinq centres d'hémodialyse ambulatoire à Calgary (Alberta). Sujets: Notre échantillon choisi à dessein était composé de 19 patients sous hémodialyse d'entretien, 2 soignants et 21 prestataires de soins de santé (7 infirmières en hémodialyse, 6 infirmières en AV et 8 néphrologues). Méthodologie: Nous avons mené des entrevues semi-structurées auprès des participants consentants. Une approche d'analyse thématique inductive a été employée pour coder les transcriptions en double et caractériser les thèmes répondant à l'objectif de recherche. Résultats: Certains points de vue sur la prise de décision en matière d'AV étaient partagés par tous les participants, mais nous avons identifié quelques domaines de divergence. Les participants s'entendaient sur : 1) l'optimisation de la préparation des patients ­ reconnaître l'état de préparation et le moment de prendre la décision; et 2) la valeur accordée aux relations de confiance avec l'équipe de soins rénaux ­ respecter l'autonomie décisionnelle après conseils. Les points de vue divergeaient sur : 1) les priorités et préférences à l'égard de l'AV ­ l'accent mis par les patients sur la minimisation des perturbations de la vie courante contrastait avec les préférences des prestataires de soins pour les fistules et l'optimisation des paramètres biomédicaux de la dialyse; 2) l'influence de l'expérience personnelle et des pairs ­ les patients préféraient des connaissances pragmatiques et expérientielles, tandis que les prestataires de soins mettaient l'accent sur la crédibilité de l'information; et 3) les critères d'évaluation de l'AV ­ la réévaluation du choix de l'AV est motivée par l'insatisfaction des patients à l'égard de l'accès et, du côté des prestataires de soins, par l'impératif médical de parvenir à un accès fonctionnel. Limites: Seules les personnes fréquentant une unité d'hémodialyse en centre urbain et à l'aise de communiquer en anglais ont pu participer. Les participants comptaient peu de patients plus jeunes et de soignants informels de personnes sous hémodialyse. Conclusion: Bien que les patients, les soignants et les prestataires de soins de santé s'entendent sur certains aspects importants de la décision concernant l'AV, celle-ci pourrait être influencée par des priorités et préférences contradictoires. Nos résultats mettent en évidence des occasions d'intégrer la prise de décision partagée dans le processus de sélection d'un AV et de combler les lacunes dans les connaissances et la préparation des patients.

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study.

RATIONALE & OBJECTIVE: Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions. STUDY DESIGN: Qualitative description. SETTING & PARTICIPANTS: Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada. ANALYTICAL APPROACH: We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles. RESULTS: 42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option. LIMITATIONS: Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants. CONCLUSIONS: Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.

The availability of support and peritoneal dialysis survival: A cohort study.

BACKGROUND: Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis. METHODS: In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018. Support was defined as the availability of a support person in the home who was able, willing and available to provide support for PD in the patient's residence. The outcome of interest was a transfer to hemodialysis for at least 90 days. We estimated the cumulative incidence of a transfer over time accounting for competing risks and hazard ratios to summarise the association between support and a transfer. We split follow-up time as hazard ratios varied over time. RESULTS: Six hundred and eighty-three incident PD patients, median age 58 years (IQR: 47-68) and 35% female, were followed for a median of 15 months. The cumulative incidence of a transfer to hemodialysis at 24 months was 26%. Having support was associated with a reduced risk of a transfer between 3 and 12 months after the start of dialysis (HR3-12mo: 0.44; 95% CI: 0.25-0.78), but not earlier (hazard ratio (HR)<3mo: 0.96; 95% confidence interval (CI): 0.55-1.69) or later (HR>12mo: 1.19; 95% CI: 0.65-2.17). CONCLUSIONS: A transfer to hemodialysis is common. Having a support person at home is associated with a short-term protective effect after the initiation of PD.

A systematic review of yoga interventions for helping health professionals and students.

Helping Health Professionals (HHP) and HHP students are among the highest risk occupational groups for compromised mental and physical health. There is a paucity of information regarding preventive interventions for mental and physical health in this group of healthcare providers. OBJECTIVE: The objective of this review was to examine the effectiveness of yoga interventions for the prevention and reduction of mental and physical disorders among HHPs and HHP students. DESIGN: An exhaustive systematic search was conducted in May 2020. Databases searched in the OVID interface included: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, and PsycINFO. EbscoHost databases searched included: CINAHL Plus with Full Text, SPORTDiscus with Full Text, Alt HealthWatch, Education Research Complete, SocINDEX with Full Text, ERIC, and Academic Search Complete. Scopus was also searched. RESULTS: The search yielded 4,973 records, and after removal of duplicates 3197 records remained. Using inclusion and exclusion criteria, titles and abstracts were screened and full text articles (n = 82) were retrieved and screened. Twenty-five studies were identified for inclusion in this review. Most frequently reported findings of yoga interventions in this population included a reduction in stress, anxiety, depression, and musculoskeletal pain. CONCLUSION: It is our conclusion that mental and physical benefits can be obtained through implementation of yoga interventions for HHPs and HHP students across a variety of settings and backgrounds. However, researchers would benefit from following recommended guidelines for the design and reporting of yoga interventions to improve study quality and rigour.

The implementation of correctional nursing practice-Caring behind bars: A grounded theory study.

AIM: To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health). DESIGN: Straussian grounded theory. METHODS: Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed. RESULTS: The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements. CONCLUSION: Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements. IMPACT: The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study.

BACKGROUND: People with end-stage kidney disease can either pursue conservative (palliative) management or kidney replacement therapy. Although transplant is preferred, there is a limited number of organs available rendering the majority of patients treated with some form of dialysis. Hemodialysis and peritoneal dialysis are equivalent regarding clinical outcomes, but peritoneal dialysis is much less costly to provide. Peritoneal dialysis is most often done in the home by the patient or a support person and carries a self-care burden on patients and families. Social support is important for patients receiving peritoneal dialysis and in sustaining peritoneal dialysis therapy. Few studies have comprehensively explored social support in the context of peritoneal dialysis. OBJECTIVE: To explore how patients, family members, and nurses view social support. DESIGN: Qualitative, descriptive study. SETTING: An outpatient peritoneal dialysis clinic in Western Canada. PARTICIPANTS: Patients, family members, and nurses. METHODS: Patients (n = 15), family members (n = 6), and nurses (n = 11) were interviewed between January and May 2018. Content analysis was undertaken using 4 attributes of social support (ie, emotional support, instrumental support, informational support, and appraisal support) as an analytic framework. RESULTS: Themes related to the 4 attributes of social support were identified: addressing emotional needs and managing emotion (emotional support); peritoneal dialysis tasks and life tasks (instrumental support); accessing information, receiving information, and learning (informational support); and affirmation/external reassurance and self-confidence (appraisal support). The social support needs of both patients and family members varied and were dependent on their existing support networks and individual perspectives of support. LIMITATIONS: It is possible that some of the study findings were gender-bound as well as context-specific. The study findings could be different if the patient and caregiver sample were more balanced based on sex. There are also unique attributes of each peritoneal dialysis program that may impact the transferability of these findings to other practice settings. CONCLUSION: Home-based peritoneal dialysis has potential benefit to patients and health care systems. However, receiving peritoneal dialysis requires support. If health care providers wish to promote this treatment, they must also understand how to best support patients and their family members. TRIAL REGISTRATION: Not applicable.

CONTEXTE: Les patients atteints d'insuffisance rénale terminale sont appelés à suivre un traitement conservateur (palliatif) ou une thérapie de remplacement rénal. Bien que la transplantation demeure préférable, le nombre d'organes disponibles contraint la majorité des patients à suivre des traitements de dialyse. Sur le plan des résultats cliniques, l'hémodialyse (HD) et la dialyse péritonéale (DP) sont équivalentes, mais cette dernière se révèle beaucoup moins coûteuse. La DP, souvent pratiquée à domicile par le patient ou une personne-aidante, impose toutefois un important fardeau au patient et à ses proches. Le soutien social est donc essentiel pour les patients traités par DP et pour soutenir cette thérapie essentielle. Peu d'études se sont penchées sur l'accompagnement des patients recevant des traitements de dialyse péritonéale. OBJECTIF: Connaître les perceptions des patients, de leurs proches et d'infirmières à l'égard du soutien social. TYPE D'ÉTUDE: Étude qualitative et descriptive. CADRE: Une clinique de dialyse péritonéale ambulatoire de l'Ouest canadien. PARTICIPANTS: Les patients, leurs proches et des infirmières. MÉTHODOLOGIE: Les patients (n = 15), leurs proches (n = 6) et des infirmières (n = 11) ont été questionnés entre janvier et mai 2018. Quatre types de soutien social (soutien affectif, instrumental ou informationnel et services d'évaluation) ont servi de cadre à l'analyse de contenu. RÉSULTATS: Des thèmes relatifs à chacun des types de soutien social ont été définis: réponse aux besoins émotionnels et gestion des émotions (soutien affectif); tâches liées à la vie quotidienne et à la dialyse péritonéale (soutien instrumental); accès à l'information, obtention de l'information et apprentissage (soutien informationnel); affirmation, réconfort et confiance en soi (services d'évaluation). Les besoins d'accompagnement des patients et de leurs proches étaient variables et dépendaient de leurs réseaux d'aide actuels et de leurs perspectives individuelles. LIMITES: Il est possible que certains résultats soient liés au sexe ou au contexte des patients. Les résultats pourraient différer avec un rapport hommes-femmes plus équilibré dans les échantillons de patients et de soignants. Aussi, chaque programme de DP présente des caractéristiques uniques pouvant avoir une incidence sur la transférabilité des résultats dans d'autres contextes de pratique. CONCLUSION: La dialyse péritonéale à domicile présente des avantages pour les patients et les systèmes de santé. La pratique de cette modalité requiert cependant du soutien. Si les fournisseurs de soins souhaitent promouvoir la DP auprès de leurs patients, ils devront également comprendre comment offrir le meilleur accompagnement possible aux prestataires et à leurs familles. ENREGISTREMENT DE L'ESSAI: Sans objet.

Development of a Culturally Tailored Motivational Interviewing-Based Intervention to Improve Medication Adherence in South Asian Patients.

BACKGROUND: South Asians (SAs) are among the fastest growing ethnic population in Western countries and have a higher risk of cardiovascular diseases relative to the general population. SAs living in Canada also have poorer adherence to medical regimens for treating cardiovascular disease, relative to other ethnic groups. Motivational interviewing (MI) maybe effective in improving health-related behaviour change in patients; however, the research is nascent on the effectiveness of MI in SAs and may also require cultural adaptation. AIM: To develop a culturally tailored MI-based intervention to improve medication adherence in hypertensive SA patients living in Canada. METHODS: Previous literature about medication adherence in SAs was reviewed, along with transcripts and responses to open-ended survey questions from our previous studies with SAs, to draft an MI intervention manual. The manual received extensive feedback from the study team, SA community members and health-care providers who work with SA patients. The feedback was used to refine the manual and make it culturally tailored and relevant to SA hypertensive patients living in Canada. RESULTS: A culturally tailored MI-based manual which we called a "motivational communication manual" was developed to support a study focused on improving medication adherence in SA hypertensive patients. The development process, components (eg, being culturally sensitive, family involvement, providing education about medications, reminders, etc.) and cultural nuances included in the manual are described in this paper. CONCLUSION: This is the first culturally tailored MI-based intervention manual that has been developed with the aim of improving medication adherence in hypertensive SA patients and that includes direct feedback from SA community members. Use of this manual may improve the accessibility and adoption of MI-based practices in improving health behaviours in SAs living in Canada as well as encourage further research studies and clinical trials with SA patients.

Motivational Interviewing in Ethnic Populations.

Motivational interviewing (MI) is an effective means of facilitating behavior change in a variety of health conditions. However, given its origins in western psychology, its utility in ethnic populations is unclear. Our objective was to examine the effectiveness of MI and its components in people of varying ethnicities and how they may experience MI. We undertook a narrative systematic review of the literature, searching only peer-reviewed research up until February, 2019 with participants who were: ≥ 18 years of age, belonging to an ethnic origin relevant to Canada's population, and had a health related concern (e.g. drug and alcohol addictions, chronic illness). Four thousand seven hundred and sixty-one citations were retrieved, and ultimately 61 met the inclusion criteria. Cultural acknowledgment and considerations with MI, when described, enhanced effectiveness of MI in most ethnic groups. The length and the number of sessions had no apparent influence on the success of MI. When examined, most study participants reported acceptance of the intervention; however, there were challenges, most notably for Chinese patients. MI can be effective in a variety of ethnic groups, particularly when cultural acknowledgement is included in the process.

South Asians' experience of managing hypertension: a grounded theory study.

OBJECTIVE: We examined the process that South Asians undergo when managing their hypertension (HTN). METHOD: Using grounded theory methods, 27 community-dwelling English-, Punjabi-, or Hindi-speaking South Asian participants (12 men and 15 women), who self-identified as having HTN were interviewed. Transcripts were analyzed using constant comparison. RESULTS: The core category was "fitting it in". First, the participants assessed their diagnosis and treatment primarily in the context of their current family/social environment. Participants who paid attention to their diagnosis either fully or partly embraced activities and attitudes associated with successful management of hypertension. However, those who did not attend to their diagnosis, identified other familial/social factors, stress of immigration, and not having symptoms of their disease as barriers. The longer the time since diagnosis of HTN, the more participants came to appropriately manage their HTN. CONCLUSION: Healthcare providers may use this information to enhance their cultural understanding of how and why South Asians manage their HTN.

The Burden of Atherosclerotic Cardiovascular Disease in South Asians Residing in Canada: A Reflection From the South Asian Heart Alliance.

South Asians (SAs), originating from the Indian subcontinent (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan), represent one quarter of the global population and are the largest visible minority in Canada. SAs experience the highest rates of coronary artery disease in Canada. Although conventional cardiovascular risk factors remain predictive in SA, the excess risk is not fully explained by these risk factors alone. Abdominal obesity, metabolic syndrome, and insulin resistance likely contribute a greater risk in SAs than in other populations. The South Asian Heart Alliance has been recently formed to investigate and recommend the best strategies for the prevention of cardiometabolic disease in SAs in Canada. This topic review represents a comprehensive overview of the magnitude of cardiovascular disease in SAs in Canada, with a review of conventional and novel risk markers in the SA population. Both primary and secondary prevention strategies are suggested and when possible, adapted specifically for the SA population. The need for SAs and their healthcare professionals to be more aware of the problem and potential solutions, along with the need for population-specific research, is highlighted.

Les Asiatiques du sud originaires du sous-continent indien (Inde, Pakistan, Sri Lanka, Bangladesh, Népal et Bhoutan) représentent le quart de la population mondiale et constituent la plus importante minorité visible au Canada. C'est aussi au sein de cette population qu'on observe les taux de coronaropathie les plus élevés au Canada. Bien que les facteurs de risque cardiovasculaire classiques conservent leur valeur prédictive chez les Asiatiques du sud, ils n'expliquent pas à eux seuls le risque excédentaire observé. L'obésité abdominale, le syndrome métabolique et l'insulinorésistance constituent vraisemblablement des facteurs de risque plus importants chez les Asiatiques du sud que dans les autres populations. La South Asian Heart Alliance a récemment été mise sur pied afin d'explorer les stratégies exemplaires pour la prévention des maladies cardiométaboliques chez les Asiatiques du sud au Canada et de formuler des recommandations à cet égard. Cette revue thématique présente un aperçu de l'importance des maladies cardiovasculaires au sein de la population des Asiatiques du sud du Canada, ainsi qu'un résumé des marqueurs de risque classiques et nouveaux dans cette population. Les auteurs proposent des stratégies de prévention primaire et secondaire adaptées, dans la mesure du possible, à la population des Asiatiques du sud. Ils font également ressortir l'importance de sensibiliser davantage les Asiatiques du sud et les professionnels de la santé aux risques et aux solutions possibles, ainsi que la nécessité de mener des recherches axées sur cette population particulière.

Exploring structural barriers to diabetes self-management in Alberta First Nations communities.

BACKGROUND: Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals' experiences with structural barriers to care and self-management remain under-characterized. METHODS: We utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants' diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10. RESULTS: The structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps. CONCLUSIONS: FN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.

The Effects of Exercise on Physical and Psychological Outcomes in Cancer Caregivers: Results From the RECHARGE Randomized Controlled Trial.

Background: Family caregivers to cancer patients are at risk for physical and psychological morbidity as a direct result of being in the caregiver role. Exercise as an intervention to support caregiver health and well-being has been tested in other caregiver populations; however, no randomized controlled trials testing the effects of an aerobic and resistance training program have been conducted where cancer caregivers only have participated. Purpose: To examine the effects of a 12-week exercise program on quality of life (Short Form 36 v2), psychological outcomes, physical activity levels, and physical fitness in caregivers to cancer patients. Methods: Seventy-seven caregivers were randomized to either an exercise intervention or wait-list control. Two participants in the exercise arm dropped out immediately after their baseline assessment. Outcome data for n = 77 participants were analyzed using intention-to-treat analysis with linear mixed models. Results: Significant group by time interaction effects were detected for exercise on the mental health component score of quality of life, self-reported weekly exercise levels, and the six-minute walk test. Small to medium effect sizes were detected on several outcomes including physical health component of quality of life (d = 0.36), mental health component of quality of life (d = 0.74), depression (d = 0.41), anxiety (d = 0.35), physical activity levels (d = 0.80), and the six-minute walk test (d = 0.21). Conclusions: The findings suggest that exercise may improve health and well-being and could be considered as an additional type of support offered to cancer caregivers. Clinical trial registration no: NCT02580461.

The evaluation of a brief motivational intervention to promote intention to participate in cardiac rehabilitation: A randomized controlled trial.

OBJECTIVES: Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet many referred patients do not participate. Motivational interviewing could be beneficial in this context, but efficacy with prospective CR patients has not been examined. This study investigated the impact of motivational interviewing on intention to participate in CR. METHODS: Individuals recovering from acute coronary syndrome (n = 96) were randomized to motivational interviewing or usual care, following CR referral but before CR enrollment. The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, barriers, self-efficacy, illness perception, social support, intervention acceptability, and CR participation. RESULTS: Compared to those in usual care, patients who received the motivational intervention reported higher intention to attend CR (p = .001), viewed CR as more necessary (p = .036), had fewer concerns about exercise (p = .011), and attended more exercise sessions (p = .008). There was an indirect effect of the intervention on CR enrollment (b = 0.45, 95% CI 0.04-1.18) and CR adherence (b = 2.59, 95% CI 0.95-5.03) via higher levels of intention. Overall, patients reported high intention to attend CR (M = 6.20/7.00, SD = 1.67), most (85%) enrolled, and they attended an average of 65% of scheduled CR sessions. CONCLUSION: A single collaborative conversation about CR can increase both intention to attend CR and actual program adherence. PRACTICE IMPLICATIONS: The findings will inform future efforts to optimize behavioral interventions to enhance CR participation.

A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation.

PURPOSE: This study explored patients' decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes. METHOD: Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts. RESULTS: Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress. CONCLUSION: The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation. Implications for Rehabilitation Cardiovascular disease is a leading cause of mortality worldwide. Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll. After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.

Retention of Ethnic Participants in Longitudinal Studies.

We aimed to identify effective participant retention strategies utilized in longitudinal studies of ethnic groups, specifically those from South Asian and Chinese communities. We conducted a systematic review of the literature focusing on the retention of ethnic minorities in longitudinal studies, up until April 2017. Only peer-reviewed research was included. 11,316 citations were retrieved, of which 4808 were duplicates and 51 met the inclusion criteria. Financial incentives, involving key community members, flexible scheduling, developing trust and personal connections with participants, and having extensive participant contact information are key facilitators. We also describe our extensive experience of retaining South Asian and Chinese participants in longitudinal studies. Key retention strategies for these groups include involving family members, informing participants about potential personal and community benefits, being flexible in how and when the interviews are conducted, and providing multiple language options. There is little published evidence or direction regarding how to retain study participants from South Asian or Chinese communities. However, there can be some learning from studies focused on other ethnic groups. Establishing an evidence-based approach, including facilitators and barriers to retention of these groups in longitudinal studies would help to determine study feasibility, validity, and ultimately to reduce health disparities among South Asian or Chinese communities.

Ethno-cultural Preferences in Receipt of Heart Health Information.

OBJECTIVE: We attempted to understand how people of South Asian and Chinese descent prefer to receive health information. METHODS: To achieve this end we conducted a search of academic and grey literature articles published between 1946 and 2016. To be included, articles had to be focused South Asian and Chinese specific ethno-culturally-based preferences of receiving health information. RESULTS: A total of 3478 abstracts were retrieved, of which, 27 articles met the inclusion criteria. We were able to identify South Asian and Chinese people's preferences for and facilitators of receiving health information. South Asians and Chinese preferred health information and programs that were more culturally relevant and appealing, had translations into South Asian and Chinese languages, and used simple terms as opposed to technical jargon. CONCLUSIONS: There is little direction regarding for how to tai- lor health information South Asian and Chinese ethno-cultural groups. Having evidence-based information about how South Asians and Chinese prefer to receive health information has potential to enhance patients' learning and health literacy, improve clinical outcomes, and reduce health disparities.

Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review.

BACKGROUND: This meta-narrative review, conducted according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standards, critically examines the construct of self-compassion to determine if it is an accurate target variable to mitigate work-related stress and promote compassionate caregiving in healthcare providers. METHODS: PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases were searched. Studies were coded as referring to: (1) conceptualisation of self-compassion; (2) measures of self-compassion; (3) self-compassion and affect; and (4) self-compassion interventions. A narrative approach was used to evaluate self-compassion as a paradigm. RESULTS: Sixty-nine studies were included. The construct of self-compassion in healthcare has significant limitations. Self-compassion has been related to the definition of compassion, but includes limited facets of compassion and adds elements of uncompassionate behavior. Empirical studies use the Self-Compassion Scale, which is criticised for its psychometric and theoretical validity. Therapeutic interventions purported to cultivate self-compassion may have a broader effect on general affective states. An alleged outcome of self-compassion is compassionate care; however, we found no studies that included patient reports on this primary outcome. CONCLUSION: We critically examine and delineate self-compassion in healthcare providers as a composite of common facets of self-care, healthy self-attitude, and self-awareness rather than a construct in and of itself.