E-Survey of Stressors and Protective Factors in Practicing Medical Assistance in Dying.

Objective: To better identify, quantify, and understand the current stressors and protective factors reported by Canadian medical assistance in dying (MAiD) assessors and providers to inform policy, education, and supports. Methods: E-survey of MAiD stressors (n = 33) and protective factors (n = 27); resilience measurement and comments relating to practice involving physicians and nurse practitioners who provide MAiD services and belong to the Canadian Association of MAiD Assessors and Providers or a francophone equivalent. The survey was conducted, while Parliament was considering changes to MAiD eligibility criteria, which occurred during COVID-19 pandemic restrictions. Results: In total, there were 131 respondents (response rate 35.8%). Two possible changes to future eligibility (mental disorders as the sole reason for MAiD and mature minors) were highly scored as were extra clinical load and patients' family conflict over MAiD. Twenty percent of respondents considered stopping MAiD work. The CD Resilience Scale-2 mean score was 6.90. Highly scored protective factors included compassionate care, relief of suffering, patient autonomy, patient gratitude, feelings of honor, privilege, and professionally satisfying work. Discussion: The identified stressors and reasons for considering stopping MAiD work indicate needs for policy, education, and supports to be optimized or developed. Respondents showed high resilience and highly scored protective factors, which should be optimized. This survey should be repeated in countries where MAiD is legal to determine stressors and protective factors in MAiD practice, stressors addressed, and protective factors enhanced where feasible in the local context for optimal care.

[Quality of disease management of sexually transmitted diseases: investigation of care in six countries in West Africa]. / Qualité de la prise en charge des maladies sexuellement transmises: enquête auprés des soignants de six pays de l'Afrique de l'Quest.

OBJECTIVES: the objectives of this study were, in healthcare facilities in six countries in West Africa, to: (1) estimate the proportion of patients consulting for sexually transmitted diseases (STDs) for whom an adequate case history was taken and who received an appropriate physical examination and effective treatement (prevention indicator PI6); (2) to determine the percentage of patients who were given advice on condom use and notification of sexual partners for STD treatment (prevention indicator PI7); (3) to determine the level of knowledge of healthcare workers concerning STD case management; and (4) to compare reported and observed behaviour regarding STD case management by healthcare workers. MATERIAL AND METHOD: this descriptive study was carried out in 240 health care facilities in six countries: Benin, Burkina Faso, Côte d'Ivoire, Guinea, Mali, and Senegal, using the WHO protocol for PI6 and PI7 indicators to evaluate the quality of management of urethral discharge and genital ulcers, as well as an extension of this protocol to evaluate STD syndromes specific to women, namely vaginal discharge and pelvic inflammatory disease. Healthcare workers were observed during STD consultations, and thereafter interviewed. Up to five observations per healthcare worker were carried out over a period of three days spent at each health care facility. Criteria for an adequate case history were inclusion of questions on the nature, time of initiation and duration of symptoms, and for physical examination, visualisation and examination of genital organs for discharge and lesions. Treatments prescribed were judged as effective when in conformity with national algorithms for syndromic STD management. The PI6 indicator was estimated as the proportion of cases where an adequate case history was taken, an appropriate physical examination carried out and effective treatment prescribed. The PI7 score corresponded to the percentage of patients who received advice on condom use and partner notification for treatment. In order to control for intra-healthcare-worker correlation, the SUUDAN software was used for the computation of 95% confidence intervals of the proportions, obtained from univariate analysis in EPI-INFO, and for the comparison of the PI6 and PI7 scores by country, sex, marital status and symptoms of the patient, as well as by level of qualification of the healthcare workers, using the khi2 test. RESULTS: overall, 613 observations and 504 interviews of 263 healthcare workers were carried out. The majority of STD patients were female (57.1%) and unmarried (53.0%). Healthcare workers were most frequently doctors (33.6%) and the most common complaint was vaginal discharge (42.2%). Intercountry variation was observed for all these variables. An adequate case history was taken in 84.6% of cases and an adequate physical examination carried out in 60.8% of cases. Healthcare workers gave a diagnosis in conformity with national syndromic STD management algorithms in 35.3% of cases, while effective treatment was given to 14.1% of patients. Patients were encouraged to use condoms in 19.5% of cases and to advise their partners to seek treatment in 50.8% of cases; this advice was given more frequently to men than to women. PI6 and PI7 scores were respectively 9.9% (95% CI: 6.9%; 12.9%) and 15.4% (95% CI: 11.4%; 19.2%). Healthcare workers' knowledge of effective STD treatment regimes was low. Practices reported during interviews with regard to STD patients were comparable to observed behaviour with regard to case history-taking and physical examination, but not for diagnosis and treatment nor for condom promotion or partner notification advice. CONCLUSION: the results of this study demonstrate the low quality of STD management in the six countries evaluated, which may be explained by the lack of availability of examination material, the inadequate knowledge of healthcare workers, as well as the infrequent promotion of STD prevention methods, particularly in women.