Health Literacy and Radiation Therapy: a Current State Assessment of Patient Education Materials.

In order to mitigate low levels of health literacy among patients, there is need to evaluate patient education (PE) materials and to ensure that the information is readily accessible to patients. The quality and comprehensiveness of radiation therapy materials were evaluated at fourteen cancer centres. To assess quality, PE leaders independently conducted readability, actionability and understandability assessments of materials. To evaluate comprehensiveness, an assessment was conducted of the scope of symptoms covered in extant materials, and the modality they were produced in (e.g. pamphlet, video). A total of 555 PE materials were reviewed for comprehensiveness and modality and seventy underwent evaluation against health literacy best practice standards. Most materials (n = 64, 91%) had a reading grade level above the recommended grade 6 ([Formula: see text] = 9, range = 4-12). Under half (n = 34, 49%) scored at or above the 80% threshold for understandability ([Formula: see text] = 74%, 33-100%) and just over half (n = 36, 51%) scored at or above the 80% target for actionability ([Formula: see text] = 71%, 33-100%). Only two cancer centres (n = 2/14, 14%) had PE materials covering the breadth of symptoms related to radiation therapy and the vast majority of materials were pamphlets (89%). Findings indicate that most radiation therapy PE materials used in cancer centres do not meet health literacy best practices, and there is a disparity between cancer centres in the topics that are available to patients and family. This evaluation highlights the need to better incorporate health literacy best practices into the development of radiation therapy PE materials and strategies to improve accessibility of such health information.

Relationships, body image, and intimacy: A pilot to increase sexual health conversations between radiation therapists and cancer patients in Ontario.

BACKGROUND: In 2016, a sexual health guideline recommended that the first step to addressing sexual health and dysfunction resulting from cancer and its treatment is for healthcare providers to initiate sexual health conversations with patients. To action this, a sexual health knowledge translation (KT) pilot was developed. METHODS: The Relationships, Body image, and Intimacy (RBI) pilot was implemented at four regional cancer centres (RCCs) from January 2018 to February 2020 which focused on medical radiation therapists (MRT(T)s) initiating conversations with radiation therapy patients. MRT(T)s were recruited to be RBI champion role models and were trained on RBI topics, trained fellow MRT(T)s, and modelled best practice for sexual health conversations with cancer patients. Pilot interventions were developed to address barriers to RBI conversations. Both qualitative and quantitative data collection activities were implemented to evaluate pilot interventions. RESULTS: Before the RBI pilot, over 80% of MRT(T)s reported they did not initiate RBI conversations with patients. By the end of the pilot, over 52% of MRT(T)s reported initiating RBI conversations with all or almost all patients. Feedback from patients was positive. Barriers to comfort level with RBI topic were successfully addressed with continued education and training throughout the pilot. DISCUSSION: Results show increased RBI conversations during the pilot, and MRT(T)s reported increased comfort speaking with patients about RBI with continued practice. The RBI champions played a pivotal role in the pilot's success and increased MRT(T) comfort with RBI. Initial barriers to RBI conversations were less reported as the pilot progressed and RBI conversations were normalized for patients. CONCLUSIONS: The RBI pilot was a novel KT initiative focused on supporting MRT(T)s to ensure patients were aware of sexual health resources available to them during their radiation therapy. Knowledge gained from this pilot can easily be adapted to assist other health care providers and additional RCCs to confidently initiate RBI conversations with their patients.

Evidence use in equity focused health impact assessment: a realist evaluation.

BACKGROUND: Equity-focused health impact assessment (EFHIA) can function as a framework and tool that supports users to collate data, information, and evidence related to health equity in order to identify and mitigate the impact of a current or proposed initiative on health inequities. Despite education efforts in both the clinical and public health settings, practitioners have found implementation and the use of evidence in completing equity focussed assessment tools to be challenging. METHODS: We conducted a realist evaluation of evidence use in EFHIA in three phases: 1) developing propositions informed by a literature scan, existing theoretical frameworks, and stakeholder engagement; 2) data collection at four case study sites using online surveys, semi-structured interviews, document analysis, and observation; and 3) a realist analysis and identification of context-mechanism-outcome patterns and demi-regularities. RESULTS: We identified limited use of academic evidence in EFHIA with two explanatory demi-regularities: 1) participants were unable to "identify with" academic sources, acknowledging that evidence based practice and use of academic literature was valued in their organization, but seen as less likely to provide answers needed for practice and 2) use of academic evidence was not associated with a perceived "positive return on investment" of participant energy and time. However, we found that knowledge brokering at the local site can facilitate evidence familiarity and manageability, increase user confidence in using evidence, and increase the likelihood of evidence use in future work. CONCLUSIONS: The findings of this study provide a realist perspective on evidence use in practice, specifically for EFHIA. These findings can inform ongoing development and refinement of various knowledge translation interventions, particularly for practitioners delivering front-line public health services.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.

BACKGROUND: Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. METHODS: On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. RESULTS: Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. CONCLUSIONS: Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care.