Relationship between sociodemographics, healthcare providers' competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study.

OBJECTIVE: Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba. DESIGN: Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men. SETTING: Community-based cross-sectional study in Manitoba, Canada. PARTICIPANTS: Community-based sample of 368 2SGBQ+ men. OUTCOMES: Logistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers' 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months. RESULTS: In multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare provider with poor (AOR=0.19, 95% CI 0.04 to 0.90) or very poor competence/knowledge (AOR=0.03, 95% CI 0.03 to 0.25) of 2SGBQ+ men's issues (compared with very good competence) was associated with lower odds of having a regular healthcare provider. Living in Brandon (AOR=0.05, 95% CI 0.02 to 0.17) and smaller towns (AOR=0.25, 95% CI 0.67 to 0.90) in Manitoba (compared with living in Winnipeg) was associated with lower odds of having a healthcare visit in the past 12 months, while identifying as a gay man compared with bisexual (AOR=12.57, 95% CI 1.88 to 83.97) was associated with higher odds of having a healthcare visit in the past 12 months. CONCLUSIONS: These findings underscore the importance of reducing the gap between the healthcare access of rural and urban 2SGBQ+ men, improving healthcare providers' cultural competence and addressing their lack of knowledge of 2SGBQ+ men's issues.

Informed consent: exploring surgical residents' beliefs, attitudes and practices.

Patients rely on the knowledge and skill of the physician proposing treatment to relay information and inform their decision-making. In academic medical centres (AMCs), surgical trainees frequently request consent on behalf of an attending surgeon. There is a paucity of knowledge regarding the frequency of this practice and any associated impacts on surgical trainees. This study poses the following queries: (1) Are surgical residents requesting informed consent (IC) while perceiving themselves to possess insufficient knowledge to facilitate the IC process? (2) If yes, what motivates a resident to request IC with inadequate knowledge? (3) Do residents experience an emotional response? (4) What, if any, support mechanisms are sought? Surgical residents in a Canadian urban AMC (n = 38) completed a survey designed to assess how surgical trainees complete the process of IC as well as probe beliefs and attitudes associated with its execution. This study finds that surgical residents frequently seek consent from patients while perceiving themselves insufficiently informed to discuss the risks and benefits of proposed procedures. The majority of participants (82%) indicated that they had personally requested consent while believing themselves inadequately aware of relevant surgical risks. Surgical trainees see this as a significant issue, feel motivated to complete the IC process due to perceived pressures, experience emotional distress and commonly seek collegial support. A cohort of residents from various surgical departments reported requesting IC while possessing inadequate knowledge to inform patient decision-making. Management of this reality could better ensure that the surgical environment both safeguards patients and enhances trainee education.

Standardized audiotape versus recorded consultation to enhance informed consent to a clinical trial in breast oncology.

BACKGROUND: The purpose of this study was to systematically compare two audiotape formats for the delivery of information relevant to informed consent to participate in a clinical trial in breast oncology, and to establish the feasibility of adding a consultation recording protocol to a clinical treatment trial. METHOD: Participants were 69 women with newly diagnosed breast cancer and 21 oncologists from 5 Canadian cancer centers. Patients were block randomized to one of three groups: 1. standardized audiotape; 2. consultation audiotape; or 3. both audiotapes. Patients received their tapes immediately following the clinical trial consultation. Patient outcomes included perception of being informed about clinical trials, knowledge of information relevant to providing informed consent to a clinical trial, and satisfaction with communication during the consultation. RESULTS: The consultation audiotapes contained less trial-related information than the standardized audiotape but there were no differences in clinical trial knowledge or perception of being informed across the intervention groups. Patients expressed a marginally significant preference for consultation audiotapes over standardized audiotapes. CONCLUSIONS: Patients tended to prefer receiving an audiotape of their own consultation over a standardized audiotape. The majority of oncologists considered the audiotape intervention feasible but were less enthusiastic about being involved in a larger study given the accrual challenges that arose when trying to "piggy-back" one randomized controlled trial on an existing clinical trial.

The Medical Humanities Program at the University of Manitoba, Winnipeg, Manitoba, Canada.

The current Medical Humanities Program at the University of Manitoba has evolved from a series of voluntary sessions into an integral element of the curriculum since its inception as the Human Values Program in 1986. With strong academic and financial support, the Medical Humanities Program has greatly benefited from dedicated leadership and a commitment to ongoing curricular review and redevelopment. The current Medical Humanities Program comprises six distinct components: Clinical Ethics; History of Medicine; Law; Complementary and Alternative Medicine; Palliative Care; and Human Values. Each of these components is compulsory and the first five are tested through examinations and assignments. Human Values sessions are designed to be experiential and to explore the human side of medicine as well as the intersections between medicine and the arts, literature, social psychology, and spirituality. The authors outline the origins and evolution of this successful program and describe its current components, student and faculty opinions, funding, advantages, disadvantages, and anticipated growth.