Older Adults With Inflammatory Bowel Disease in Canada: A Mixed-Methods Exploratory Study of Care Experiences and Health-Related Quality of Life.

Literature exploring the health-related quality of life and care experiences of older adults with inflammatory bowel disease is limited despite the increasing prevalence in this population. The purpose of this study was to explore the perceived health-related quality of life and care experiences in older adults with inflammatory bowel disease in Canada. This study used a mixed-methods convergent design consisting of a descriptive, cross-sectional survey and qualitative descriptive interviews. Fifty-eight participants completed the survey and 24 participants completed interviews. Older adults reported satisfaction with inflammatory bowel disease-related care, high levels of disease control, moderate health-related quality of life, and low levels of patient-healthcare team interactions. Themes identified were (1) Experiences of inflammatory bowel disease in daily life; (2) Accessibility of inflammatory bowel disease-related health services; and (3) Communication and relationships to facilitate inflammatory bowel disease care. Ultimately, quality inflammatory bowel disease care for older adults is contingent upon communication between patients and providers, access to multidisciplinary clinics, and support networks. By ensuring these factors are present, providers and patients can work together collectively toward positive patient outcomes, enhanced satisfaction with care, and greater perceived quality of care.

The Experiences of Older Adults Living With Inflammatory Bowel Disease: A Scoping Review.

The prevalence of inflammatory bowel disease is rising in persons older than 65 years. Although there is extensive literature on inflammatory bowel disease in older adults from a disease-related outcome, epidemiological, and treatment perspective, the older adult perspective on inflammatory bowel disease-related care needs and experiences is not well represented. This scoping review examines the existing literature regarding the care experiences of older adults living with inflammatory bowel disease. A systematic search was conducted using 3 concepts: older adults, inflammatory bowel disease, and patient experience. Seven publications met the inclusion criteria. Reported data include study design and methods, sample characteristics, and findings relevant to the research question. Two themes were identified: preferences for interactions with healthcare personnel and peer support networks, and barriers to accessing care for inflammatory bowel disease needs. An overarching concept across all studies was the need and request for individualized, patient-centered care where patient preferences are considered. This review highlights the need for more research on the older adult age group to guide evidence-informed practice that meets their individual inflammatory bowel disease care needs.

Perspectives of health care use and access to care for individuals living with inflammatory bowel disease in rural Canada.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract with no known cure. Management of IBD is complex and requires those with IBD to have lifelong interactions with the healthcare system. Individuals with IBD who live in rural areas are at risk of poorer health outcomes due to their limited access to care. This study examined healthcare utilization and access to care for rural adults with IBD. The research questions explored in this study were: What are the care experiences of healthcare providers (HCPs) and persons living with IBD in rural areas? What are the enablers and barriers to optimal IBD care in rural environments? What strategies are necessary to enhance care delivery for these individuals with IBD? METHODS: This patient-oriented research initiative involved patient and family advisors as active and equal team members in decision-making throughout the project. This article reports on the qualitative findings of a larger mixed-methods study. The setting was one western Canadian province. Fourteen individuals with IBD living in rural areas and three HCPs working in rural areas participated. Interview data were analyzed using thematic analysis. RESULTS: Three themes were identified: communication, stressors and support systems, and coordination of care. Communication with and between HCPs was challenging due to the distance to access care. Participants described challenges related to rural HCPs' lack of IBD-related knowledge. Virtual communication, such as telehealth and phone clinics, was infrequently used yet highly recommended by participants. Individuals with IBD described various stressors and feelings of isolation while living in rural environments, and both participant groups described the need for additional formal and informal support systems to ease these stressors. Coordination of care was considered essential to optimal health outcomes, but individuals frequently experienced gaps in care. Lack of local services such as outpatient clinics, hospitals, laboratory testing, infusion clinics, and pharmacies meant individuals with IBD frequently had to travel to access care. Some participants reported bypassing existing local services, instead preferring the expedited, specialist care within larger centers. CONCLUSION: Most participants described challenges associated with living in rural areas and suggested health system improvements. Access to multidisciplinary care teams, including IBD physicians and nurses, psychologists, and dieticians, for individuals in rural areas is encouraged, as is the use of virtual care delivery options such as telehealth, online clinics, telephone clinics or advice lines, web-based video-conferencing, and email communication to increase access to care. Continued efforts to recruit and retain rural HCPs with knowledge of IBD are deemed necessary to provide continuity of care within rural environments. Strengthening formal and informal support systems and enhancing psychosocial supports in rural communities are warranted to ensure optimal wellbeing. Online strategies to provide individual and group education related to IBD are strongly recommended. Facilitating access to care in rural areas can increase disease remission, decrease direct and indirect care costs, and promote quality of life in individuals with IBD.

Inflammatory Bowel Disease Nurses' Perspectives: Prioritizing Adolescent Transition Readiness Factors.

PURPOSE: Despite the wealth of knowledge and expertise that Inflammatory Bowel Disease (IBD) nurses bring to the transition process, health literature lacks nurses' perspectives on transition readiness. The purpose of study was to ask IBD nurses to prioritize care transition readiness factors for adolescents living with IBD. DESIGN AND METHODS: The cross-sectional exploratory survey was researcher-developed and distributed online to IBD nurses across Canada. The survey was divided into nine transition topic categories. RESULTS: Fifty-six female registered nurses from six Canadian provinces participated in the study. Overall, nurses rated all items within each transition topic category to be very important in facilitating adolescent transition to adult healthcare. The highest individual mean scores and the highest prioritized categories were within the Knowing IBD and Healthcare Provider Relationships categories, emphasizing the importance for adolescents to understand their disease and feel comfortable communicating their needs and questions to healthcare providers. CONCLUSIONS: The transition process needs to be individualized and comprehensive addressing a multitude of biopsychosocial factors in order to support IBD patients and families to achieve healthy adult self-care behaviours that can foster positive health outcomes. PRACTICE IMPLICATIONS: Healthcare providers, adolescents, and parents must work collaboratively to achieve identified transition goals so that the transition process is a mutually satisfying experience. A comprehensive readiness assessment tool is suggested to assist in the transition process. Transition readiness assessment must start early, be ongoing, be age-appropriate, and be individualized to the patient needs.

Establishing a mentorship program in rural workplaces: connection, communication, and support required.

INTRODUCTION: Recruitment and retention of healthcare providers to rural workplaces is often challenging due to many factors, such as complex work environments requiring a broad skill set, minimal staffing, and limited community support and resources. Mentorship has been proposed as a strategy to encourage recruitment and retention of staff in rural workplaces. This article describes a rural-specific pilot mentorship program that was implemented and evaluated in terms of supporting rural mentorships, easing workplace transition, strengthening community connections, and encouraging recruitment and retention in rural communities. METHODS: Thirty volunteer registered nurse mentors and mentees were recruited from within a western Canadian province. These individuals worked in communities with populations of less than 10 000. Mentors and mentees were matched by program coordinators based on self-identified relationship priorities and similar responses to questions including preferred frequency and method of contact. Online orientation to the program was provided and the formal mentorship lasted 4 months. Follow-up program evaluation was conducted via informal electronic feedback and comprehensive interviews that were analyzed using thematic analysis. RESULTS: Three themes were identified by participants that serve as key considerations when implementing a rural mentorship program: connection, communication, and support. Connection describes the variety of relationships participants formed throughout the mentorship program, including connections to their mentor/mentee, themselves, their profession, colleagues, and the larger rural community. Communication includes the logistics of corresponding between mentee-mentor dyads during the program, participant communication with the coordinators of the program, and future communication about and promotion of rural mentorship programs. Support was described as interpersonal and professional assistance provided to the mentee from the mentor as well as to the mentor from the mentorship program and management. Data from the study suggest that rural-specific mentorships are effective in terms of supporting mentorships, easing workplace transition, strengthening community connections, and encouraging recruitment and retention of registered nurses in rural health care. Pervasive throughout the themes derived from the thematic analysis of interview data was the pivotal role of four key groups (mentors, mentees, the healthcare organization, and the rural community) in developing, facilitating, and sustaining mentorships in rural areas. CONCLUSION: Participants in this study believed that mentorship was beneficial to support healthcare providers working in rural environments. However, greater strides need to be made in terms of creating and supporting such relationships. The responsibility for mentorship resides with not only the mentor and mentee but also health organizations and rural communities. Members from all groups need to be committed and contribute to mentorship for rural mentorship programs to be successful and sustainable. Rural residents are often underserved due to insufficient numbers of healthcare professionals working in rural areas along with a limited number of services offered. The greater the numbers of healthcare professionals that can be recruited and retained within rural communities, the greater the likelihood the community residents will have timely and appropriate access to quality health services. These services can result in positive patient outcomes and greater community health.

Healthcare Transition in Pediatrics and Young Adults With Inflammatory Bowel Disease: A Scoping Review.

The incidence of inflammatory bowel disease has steadily increased in children within the last decade. As young adults transition into the adult healthcare system, lack of support can lead to disease exacerbations and disease-related complications. The purpose of this scoping review was to examine the current healthcare transition literature in pediatrics and young adults with inflammatory bowel disease, with a particular focus on assessment or screening tools to evaluate healthcare transition readiness. Five most relevant databases were searched. Of these, 22 articles met the inclusion criteria and key findings from these are summarized. The majority of articles focused on adolescents or young adults with inflammatory bowel disease and were primarily published in the United States. Since 2008, there has been a growing trend in publications of inflammatory bowel disease healthcare transition literature. Articles were often described as healthcare transition readiness assessment tools, patient outcomes following transition, or transition experiences and barriers. An understanding of the current literature on the readiness assessment and support strategies is required to promote an improved quality of life for pediatric and young adult patients living with inflammatory bowel disease.

Supporting nurses' transition to rural healthcare environments through mentorship.

INTRODUCTION: The global shortage of rural healthcare professionals threatens the access these communities have to adequate healthcare resources. Barriers to recruitment and retention of nurses in rural facilities include limited resources, professional development opportunities, and interpersonal ties to the area. Mentorship programs have been used to successfully recruit and retain rural nurses. This study aimed to explore (i) employee perceptions of mentorship in rural healthcare organizations, (ii) the processes involved in creating mentoring relationships in rural healthcare organizations, and (iii) the organizational features supporting and inhibiting mentorship in rural healthcare organizations. This study was conducted in one rural health region in Saskatchewan, Canada. METHODS: Volunteer participants who were employed at one rural healthcare facility were interviewed. A semi-structured interview guide that focused on exploring and gaining an understanding of participants' perceptions of mentorship in rural communities was employed. Data were analyzed using interpretive description methodology, which places high value on participants' subjective perspective and knowledge of their experience. RESULTS: All seven participants were female and employed as registered nurses or licensed practical nurses. Participants recognized that the rural environment offered unique challenges and opportunities for the transition of nurses new to rural healthcare. Participants believed mentorships facilitated this transition and were vital to the personal and professional success of new employees. Specifically, their insights indicated that this transition was influenced by three factors: rural community influences, organizational influences, and mentorship program influences. Facilitators for mentorships hinged on the close working relationships that facilitated the development of trust. Barriers to mentorship included low staff numbers, limited selection of volunteer mentors, and lack of mentorship education. CONCLUSIONS: The rural community context clearly presents challenges for the transition of nurses. Participants described mentorship as a vital component to personal and professional success of new employees in rural areas. The findings of this qualitative exploratory study inform the development of creative and supportive ways to establish mentorships to address the challenges specifically associated with integration of nurses into rural practice.

The Saskatchewan Caregiver Experience Study: Support Priorities of Caregivers of Older Adults.

BACKGROUND: Population aging is a global phenomenon. Many older adults living with chronic conditions rely on family and friend caregivers. The growing demand for family and friend caregivers underscores the necessity for adequate and effective support services. PURPOSE: The Saskatchewan Caregiver Experience Study sought to gather the perspectives of caregivers of older adults and set priorities for caregiver support. METHODS: An online survey with open-ended questions was employed in this qualitative descriptive study. In this manuscript, we present our findings from the survey question: "What do you think is most important for support in your caregiving role? In other words, what are your top priorities for support?" FINDINGS: This survey question received n = 352 responses, evenly distributed across Saskatchewan in urban-large (33%), urban-small/medium (32%), and rural (35%) settings. Support priorities of Saskatchewan caregivers were found to be access to help when they need it; an ear to listen and a shoulder to lean on; assistance in optimizing the care recipient's health; having healthcare professionals that care; and improved policies, legislations, and regulations. CONCLUSION: Services and interventions that assist caregivers are more likely to be accessed and utilized when caregivers are given the opportunity to identify their own support priorities. This study has the potential to inform health and governmental systems to support caregivers of older adults provincially within Saskatchewan, nationally in Canada, and in a global context.

Mapping the Caregiver Experience in a Canadian Province: Research Methodology for the Saskatchewan Caregiver Experience Study.

BACKGROUND: Policies and services for older adults are increasingly focused on living in the community, rather than relying on institutions. A total of 70-80% of community care for older adults is provided by family and friend caregivers. With Canada's aging population, the number of caregivers to older adults is growing. PURPOSE: The purpose of this paper is to describe the research methodology that was employed in the Saskatchewan Caregiver Experience Study. The methodology was used to map the experiences and gather perspectives of caregivers in Saskatchewan and to identify their priority support needs. METHODS: Qualitative description was the approach in this study. An online qualitative survey was administered via SurveyMonkey and distributed via Facebook and community newsletters. The survey collected caregiver demographics and asked three open-ended questions regarding: (1) the challenges that caregivers experience; (2) the positive aspects of caregiving; and (3) the support needs and priorities of Saskatchewan caregivers. A fourth question where caregivers could freely express any other experiences or perspectives was included. Content analysis was the method used for data analysis. RESULTS: 355 individuals met the inclusion criteria for this study. Participants were evenly distributed amongst urban-large, urban-small/medium, and rural settings in Saskatchewan. The average age of caregivers and care recipients were 61 and 83 respectively. CONCLUSION: This study has implications for research, practice, and policy. By gathering the full spectrum of the caregiver experience in Saskatchewan, this study can help to inform how communities, governments, and our healthcare system can best support caregivers in their role.

Identification and prioritization of patient-centred strategies to enhance IBD-related care for older adults: a modified Delphi approach.

Background: The older adult age group makes up one of the fastest-growing groups of individuals with inflammatory bowel disease (IBD). It is important to hear the perspectives of older adults living with IBD about care experiences and managing their illness. The purpose of this patient-oriented study was to identify and prioritize patient-centred strategies that have the potential to enhance IBD-related care for older adults in Saskatchewan. Methods: The interprofessional research team, consisting of older adult individuals living with IBD, gastroenterology providers, and researchers specializing in IBD or older adult education used a modified Delphi approach to identify and prioritize strategies that may enhance IBD-related care for older adults. Thirty-one older adults with IBD participated in ranking, revising, and prioritizing statements related to their chronic illness care. Nine statements were developed that highlighted strategies for older adult IBD care. Results: Through the consensus process, 6 statements were retained. Co-creating a treatment plan with the IBD provider was ranked as the top priority statement for older adults with IBD. Conclusion: Facilitating collaborative relationships and understanding individual priorities for IBD-related care for older adults has the potential to enhance positive health outcomes and quality of life for these individuals.

Exploring the Experiences of Virtual Inflammatory Bowel Disease Care in Saskatchewan.

BACKGROUND: Individuals with inflammatory bowel disease (IBD) require life-long interactions with the healthcare system. Virtual care (VC) technologies are becoming increasingly utilized for accessing healthcare services. Research related to the use of VC technology for the management of IBD in Canada is limited. This study aimed to examine the VC experiences from the perspectives of individuals with IBD and gastroenterology care providers (GCPs). METHODS: A patient-oriented, qualitative descriptive approach was used. Semi-structured interviews were completed with individuals with IBD and GCPs. Data were analyzed using an inductive content analysis approach. RESULTS: A total of 25 individuals with IBD and five GCPs were interviewed. Three categories were identified: benefits of virtual IBD care delivery, challenges of virtual IBD care delivery, and optimizing IBD care delivery. Individuals with IBD and GCPs were satisfied with the use of VC technology for appointments. Participants believed VC was convenient and allowed enhanced access to care. However, VC was not considered ideal in some instances, such as during disease flares or first appointments. Thus, a blended use of virtual and in-person appointments was suggested for individualized care. CONCLUSIONS: The virtual method of connecting patients and providers is deemed useful for routine appointments and for persons living in rural areas. VC is becoming more common in the IBD care environment. Nurses are in a key position to facilitate and enhance virtual IBD care delivery for the benefit of both individuals living with IBD and providers.

Adaptation and Validation of a Questionnaire to Measure Satisfaction With Telephone Care Among Individuals Living With Inflammatory Bowel Disease.

Background: Individuals with inflammatory bowel disease (IBD) require routine medical follow-up. The usage of telephone care (TC) appointments increased because of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to adapt a questionnaire to evaluate satisfaction with TC use and validate it among IBD individuals. Methods: A committee of experts adapted the Telehealth Usability Questionnaire to the TC context and validated its use in individuals with IBD. This committee included three IBD gastroenterology care providers (GCPs), two IBD-patient partners, and two healthcare researchers. The committee evaluated the content validity of the adapted items to measure TC satisfaction. A pilot study assessed the readability and usability of the questionnaire. Individuals with IBD in Saskatchewan completed an online survey with the adapted questionnaire between December 2021 and April 2022. Data were analyzed using descriptive and correlational techniques. Psychometric analyses were conducted to examine the reliability and validity of the questionnaire. Results: The committee of experts developed the Telephone Care Satisfaction Questionnaire (TCSQ patient), with 16 items and one overall item for TC satisfaction. After the pilot, 87 IBD individuals participated in the online survey. A strong correlation was observed between the 16-item standardized level of TC satisfaction and the overall item, r = 0.85 (95%CI 0.78-0.90, p < 0.001). The TCSQ patient had optimal internal reliability (α = 0.96). Two dimensions were identified in the exploratory factor analysis (i.e., TC usefulness and convenience). Conclusion: The TCSQ patient is a valid and reliable measure of TC satisfaction among individuals with IBD. This questionnaire demonstrated excellent psychometric properties and we recommend its use.

Health care providers' perceptions of burnout and moral distress during the COVID-19 pandemic: A qualitative study from Saskatchewan, Canada.

OBJECTIVES: This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic. METHODS: This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach. RESULTS: We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions. CONCLUSION: Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.

Improving access to inflammatory bowel disease care in Canada: The patient experience.

OBJECTIVES: Canada has one of the highest age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Large patient volumes and limited resources have created challenges concerning the quality of IBD care, but little is known about patients' experiences. This paper aimed to better understand patient-perceived barriers to IBD care. METHODS: An exploratory qualitative approach was used for this study. Fourteen focus groups (with 63 total participants) were co-facilitated by a researcher and patient research partner across eight Canadian provinces in 2018. Patients diagnosed with IBD (>18 years of age) and their caregivers were purposefully recruited through Crohn's and Colitis Canada, gastroenterology clinics and communities, and national social media campaigns. Focus group sessions were recorded, transcribed, and analyzed using thematic analysis. RESULTS: Most participants self-identified as being white and women. The analysis generated four key themes regarding patient-perceived barriers and gaps in access to IBD care: (1) gatekeepers and their lack of IBD knowledge, (2) expenses and time, (3) lack of holistic care, and (4) care that is not patient-centered. An additional four themes were generated on the topic of patient-perceived areas of health system improvement for IBD care: (1) direct access to care, (2) good care providers, (3) electronic records and passports, and (4) multidisciplinary care or an 'IBD dream team'. CONCLUSIONS: This research contributes to the limited global knowledge on patients' experiences accessing IBD care. It is valuable for the development of care plans and policies to target gaps in care. Patients have identified system-level barriers and ideas for improvement, which should be taken into consideration when implementing system redesign and policy change.

Organizational Supports for Nurse Managers in a North American Context: A Scoping Review.

Organizational support for nurse managers (NMs) is not a new phenomenon. However, generally speaking, NMs are not well supported in their roles. This lack of support is burdensome to NMs' role functioning and has impacts on NM recruitment and retention; NM job satisfaction; and outcomes for front-line nurses and patients. There is a gap in the nursing literature as to what supports are currently in place to effectively support NMs. A scoping review (n = 24) focusing on North American healthcare organizations was conducted to examine what organizational supports are currently in place to support NMs and highlight gaps. Arksey and O'Malley's (2005) scoping review framework was used for this review. NM supports are currently lacking; however, they do include orientation to the NM role; competency and professional development; ancillary and clinical support; and support from upper management. The implications for nursing leadership related to organizational supports and gaps in supports for NMs are presented. Healthcare organizations have work to do in order to better support NMs and ensure quality work environments that facilitate the successful functioning of NMs at all stages of their career.

How do Registered Nurses Understand Followership?

BACKGROUND: Despite a consensus that followers and leaders are interdependent, the focus of nursing education, practice, and research has been leader centred. This has spawned calls in the nursing literature for increased scholarship on followership in nursing. PURPOSE: To develop a grounded theory of followership in nursing. METHOD: This study addressed the question - how do registered nurses understand followership? 11 registered nurses participated in online interviews that were later transcribed and analyzed following Charmaz's approach to Constructivist Grounded Theory. RESULTS: The core category of trusting informal and formal leaders was co-constructed from the data. A conceptual model, titled Followership as Trust in Acute Care Nursing Teams, illustrates that the nurses' decision to trust (and subsequently to engage in following) hinges on sharing the load (understanding one's role, accepting one's role, and working together); demonstrating knowledge (having experience, modelling, and mentoring); and connecting through communication (knowing the goal and communicating clearly). When participants fully trust formal and informal leaders, they engage in following as proactive members of the team, provide solutions to problems, and take initiative. Conversely, when they are less trusting of informal and formal leaders, they are less willing to follow. CONCLUSIONS: This study underscores the importance of trust between followers and leaders for effective team function and safe patient care. More research on the follower-leader dynamic in nursing is needed to inform education, policy, and practice so that every nurse possesses the knowledge and skill to be both a follower and a leader.

An Exploratory Study of Health-related Quality of Life and Care Experiences in Older Adults with Inflammatory Bowel Disease.

Canada has one of the highest rates of inflammatory bowel disease (IBD), with older adults as the fastest-growing group of individuals affected. This exploratory mixed methods study aimed to understand perceived health-related quality of life and care experiences in older adults with IBD. Participants greater than 60 years of age, who were diagnosed with IBD, and who lived in Saskatchewan, Canada were invited to participate in both an online survey and telephone interview. Seventy-three respondents completed the survey, and 18 participants were interviewed. Most individuals were diagnosed before age 60, believed their IBD was well controlled, believed their current treatment was useful, and were satisfied with their care. Individuals also reported a moderate health-related quality of life. However, collaborative management of IBD care between providers and older adults with IBD was identified as an area with room for improvement. Strategies to enhance disease self-management and engaged chronic illness care are critical.

Crohn's Disease Patient Experiences and Preferences With Disease Monitoring: An International Qualitative Study.

Background: Strategies incorporating objective disease monitoring in Crohn's disease (CD), beyond clinical symptoms are important to improve patient outcomes. Little evidence exists to explore patient understanding of CD treatment goals, nor preferences and experiences with monitoring options. This qualitative study aimed to explore patient experiences and preferences of CD monitoring to inform monitoring strategies, improve patient engagement, and optimize a patient-centered approach to care. Methods: This study used a patient-oriented, qualitative descriptive design. Convenience and snowball sampling were used to recruit adult participants diagnosed with CD who had experience with at least 2 types of disease monitoring. Online focus groups were conducted and data were analyzed using thematic analysis. Results: This international study included 37 participants from Australia, Canada, United Kingdom, and the United States. Overall, participants preferred more noninvasive types of monitoring [eg, intestinal ultrasound (IUS)] but were willing to undergo more invasive monitoring (eg, colonoscopy) if required. To improve disease monitoring, participants wanted increased access to IUS, establishment of a patient-centered interdisciplinary team and access to information and self-testing. Participants identified challenges with communication between patients and providers and stressed the importance of participating in shared decision making and being equal team members in their care. Conclusions: It is imperative to incorporate patient-driven preferences into how we can best structure monitoring strategies, to ensure equitable access to those preferred modalities and embrace a shared decision-making approach to disease management in CD.

Time for a Gut Check: A Qualitative Study of Proposed Interventions to Address Gender Inequality in Gastroenterology.

Background: Gender inequalities persist in medicine, particularly in some speciality fields where fewer women are employed. Although previous research has suggested potential interventions to broadly address gender inequality in medicine, no research has focused on interventions in the field of gastroenterology. The purpose of this research was to engage women in the field of gastroenterology in Canada, to identify interventions with potential to be effective in addressing gender inequality. Methods: A World Café was hosted in 2019 to discuss gender inequality and interventions in gastroenterology. Twelve women employed in the field of gastroenterology (i.e. physicians, nurses, research staff, and trainees) were purposively recruited and participated in the event. The discussion rounds were audio-recorded, transcribed, and thematic analyses was conducted using Braun and Clarke's principles. Results: Three key themes identifying potential interventions to address gender inequality in gastroenterology were generated: (1) Education; (2) Addressing institutional structures and polices; and 3) Role modelling and mentorship. Participants indicated that interventions should target various stakeholders, including both women and men in gastroenterology, young girls, patients, and administrators. Conclusion: Many of the interventions identified by participants correspond with existing research on interventions in general medicine, suggesting that institutional changes can be made for maximum effectiveness. Some novel interventions were also identified, including publicizing instances of gender parity and supporting interventions across the educational and professional lifecourse. Moving forward, institutions must assess their readiness for change and evaluate existing policies, programs, and practices for areas of improvement.

Patient-Centered Access to IBD Care: A Qualitative Study.

Background: Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with IBD with a focus on accessing health care. Methods: Using a qualitative descriptive approach, patients diagnosed with IBD (≥18 years of age) were purposively sampled from rural and urban gastroenterology clinics and communities across Canada. Co-facilitated by a researcher and patient research partner, 14 focus groups were recorded, transcribed, and coded for themes. Thematic analysis was used to ascertain the congruence or discordance of IBD specialty care access experiences. Results: A total of 63 individuals participated in the study. The majority of participants were female (41/63, 65%) and from urban/suburban regions (33/63, 52%), with a mean age of 48.39 (range 16-77 years). The analysis generated three main themes: (1) need for patient to be partner, (2) adapting IBD care access to individual context, and (3) patient-defined care priorities should guide access to IBD care. Conclusions: The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the impact of these factors on accessing care. Using a patient-centered exploration of barriers and facilitators, IBD specialty care access in Canada can be better understood and improved on provincial and national levels.