The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial.

BACKGROUND: The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland. METHODS: The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021. DISCUSSION: This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care. TRIAL REGISTRATION: ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.

Charting the trajectory of domestic violence policy change in the Republic of Ireland since the mid-1990s - a path towards integration?

INTRODUCTION: This paper assesses the policy developments pertaining to the implementation of an integrated approach to domestic violence over the past 15 years. The contextual setting is outlined in terms of the international policy response to the problem of domestic violence based on an ecological perspective. DESCRIPTION OF POLICY AND CASE: Periods of core strategic policy and related structural developments are considered illustrating the Irish experience of domestic violence policy-making and service provision. The value of adopting an integrated approach to domestic violence based on the rationale of improving strategic policy formulation, coordinating service provision and facilitating joined-up governance is set out. The core facilitators and challenges associated with such an approach are described. ANALYSIS AND CONCLUSION: The policy framework and restructured landscape of domestic violence in Ireland has undergone significant change over the past decade and a half. The paper uses a three-dimensional matrix of domestic violence policy development and service integration as a means of addressing horizontal, vertical and resource aspects of collaboration and integration. While the changes have been characterised by significant phases of fluctuation in terms of coordinated action and the situation currently appears promising, however it is too early to judge the outcomes of the most recent reforms.

Impacts of an HIA on inter-agency and inter-sectoral partnerships and community participation: lessons from a local level HIA in the Republic of Ireland.

This study evaluates the impacts of a locally based health impact assessment (HIA) on community participation, inter-sectoral and inter-agency partnership in local decision and policy-making processes. The methods comprised a series of semi-structured interviews with key informants followed by thematic analysis of transcribed responses. The study revealed a number of positive impacts among both community and service providers. A particularly advantageous impact was the facilitation of community learning through a local action group formed as a recommendation of the HIA that provided community development and HIA training. During the HIA process all participants increased their knowledge of health determinants and recognized a broader range of evidence sources for local decision-making. Participants also developed a greater understanding of each other's roles and perspectives. Additionally, the study revealed a number of barriers to HIA. Differing views on the role of HIA were evident whereby community members tended to regard HIA as an advocacy tool for local issues impacting on health in their locality, while service providers perceived its role more in terms of networking and collaboration. A key area remaining to be tackled in terms of partnership working is the approach of service agencies to enabling meaningful community participation in local decision-making processes. In this respect, attention to the cultural dimension of inter-sectoral working, and the need for training for both service agency staff and community members prior to or at the initial stages of HIA are required. Such changes could facilitate more meaningful community inclusion and help to address the current power imbalance between these two sectors.

Time for a paradigm change? Tracing the institutionalisation of health impact assessment in the Republic of Ireland across health and environmental sectors.

This paper presents a critical analysis of health impact assessment (HIA) in the Republic of Ireland (ROI) in the context of institutional policy and practice. It begins with a brief background to the origins and aims of HIA. Core developments in health and environmental sectors pertaining to HIA in the ROI are then considered. A series of significant developments have taken place in these sectors over the past decade that are positively associated with the promotion of HIA in the ROI. However, it is argued that in spite of various institutional facilitators, the practice of implementing HIAs in the ROI is significantly underdeveloped, and it continues to lag behind several of its European Union counterparts. It is contended that a paradigm change is required in order to address the current policy-action gap. An organisation theory framework is used to assess the implementation problem and a number of suggestions are highlighted as potential facilitators of this process.