No abstract

Objective To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter.Background Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers.

Background: Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics. Method: Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined. Results: A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period. Conclusion: The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardestto-reach group. La traduction du résumé se trouve à la fin de l'article.

A 1992 chart review in the Haida Village of Skidegate, Haida Gwaii/Queen Charlotte Islands, Canada, revealed that 17% of the unscreened population aged 35 or over have been diagnosed with diabetes. The Haida Gwaii Diabetes Project was designed to develop a culturally sensitive community-based participatory action approach to the management of noninsulin-dependent diabetes (NIDDM). Phase One included obtaining community support, conducting a chart review, holding clinics to measure biophysical indicators, conducting focus groups, and planning response activities with the communities. A list of activities was developed, based on the focus group results. In addition, the project team developed a set of operating principles that ensured and reinforced collaboration. Phase Two included implementing and monitoring planned response activities, and holding exit clinics. The best attended activities were trials of traditional herbal medicine and traditional diet, and an exercise programme. While participation levels were not high enough for causal conclusions, a significant decrease in total cholesterol (0.45; P = 0.005) and rise in HDL (-0.097; P = 0.05) was found for participants for whom paired values were available. Diabetes intervention research in First Nations settings involves small numbers of participants, making it difficult to quantitatively assess outcomes. To increase participation it is advisable to open activities to the whole community, to tie planned activities into other scheduled community events, and to share findings concerning managing illnesses of acculturation with other communities.

Objective: This study describes rescreening following a prison cervical cancer screening intervention: the numbers of women who received rescreening during the three-year follow-up period; their timing of rescreening in relationship to intervention follow-up recommendations; and socio-demographic factors associated with rescreening. Methods: Socio-demographic information was collected from Corrections Branch records. Clinical and risk factor information was obtained by a self-administered questionnaire. Pap screening histories were collected from Cervical Cancer Screening Program (CCSP) client records using the client ID number for Pap smears taken during the intervention period, during the three-year follow-up period, and during the 30-month period preceding the intervention period. Results were entered in Excel and responses summarized with frequency tables; bivariate analysis of categoric variables was done using chi-square tests of independence. Results: During the three-year follow-up period, only 28 (21%) of 138 women who participated in a prison cervical cancer screening intervention were rescreened within 6 months of the recommendation received at intervention Pap test. Women with fewer than 5 multiple names (aliases) were more likely to be rescreened (p=0.02). Educational level approached statistical significance (p=0.05), with women with least education receiving highest rescreening. There was no relationship between rescreening and ethnicity, injection drug use, having borne children and current methadone treatment. Conclusion: Only 50% of women who participated in a specifically designed prison screening intervention were rescreened during the subsequent three years. Further work is needed to design, implement and evaluate follow-up initiatives of community cervical cancer screening programs for women who are at higher risk of developing cervical dysplasia.