Canada’s vast geography, and centralized delivery of cancer care and clinical trials create barriers for trial participation for patients in remote and rural settings. The development and implementation of a framework that enables safe and regulatory compliant trial participation through local healthcare providers would benefit Canadian patients, clinicians, trial sponsors and the health care system. To address this issue, representatives of Canada’s cancer clinical trial community met to identify key challenges and develop recommendations for remote patient participation in trials. A structured literature review identified remote/rural trial delivery models. A panel of expert stakeholders reviewed the models and participated in a workshop to assess health system readiness, identify needed processes, tools and mechanisms, and develop recommendations for a Canadian framework for decentralized clinical trial conduct. The Canadian Remote Access Framework for clinical Trials (CRAFT) represents a risk-based approach used by site investigators to delegate responsibilities for a given trial to satellite health centres within a hub-and-spoke “trial cluster”. The Framework includes specific recommendations to ensure research experience, capacity, regulatory compliance and patient safety. Canada’s cancer care and telemedicine systems can be leveraged to enable broader access to clinical trials for patients who are geographically remote from cancer centres. CRAFT’s risk-based framework is based on other successful models of remote trial patient management and is in the pilot implementation phase in Canada.
Adolescent girls in Nepal face enormous social barriers to accessing education and health services due to exclusionary socio-religious traditions and years of conflict. The programme and study reported here address two issues that a national assembly of in-school and out-of-school adolescent girls, who had completed a basic life skills class, and, in the case of unschooled girls, an intensive literacy course, identified as important to their well-being - menstrual restrictions and HIV awareness and prevention. Local non-governmental organizations developed a peer education programme in three districts of Nepal that paired girls from different castes and different educational levels. The programme sought to increase peer educators' (PE) leadership and collective efficacy for informing peers and adults in their communities about the effects that these issues have on women and girls. In total, 504 girls were selected and trained as PEs. They conducted targeted discussion sessions with other girls and organised mass awareness events, reaching 20,000 people. Examination of the effects of participating in the programme on key outcome measures showed that leadership self-efficacy, which was a central theoretical construct for the programme, provided a strong predictor of both increased HIV knowledge and of practicing fewer menstrual restrictions at endline. The project demonstrated that girls from different caste and educational backgrounds are able to work together to change individual behaviour and to address socio-cultural norms that affect their lives and well-being within their communities.
Background:Before the COVID-19 pandemic, healthcare providers (HCPs) were already experiencing a higher prevalence of mental health disorders compared with non-healthcare professionals. Here, we report on the psychosocial functioning and stress resilience of HCPs who worked during the COVID-19 pandemic in a large-sized psychiatric facility and a large acute care hospital, both located in central Ontario, Canada.Methods:Participants completed five validated psychometric instruments assessing depression, anxiety, and stress (The Depression, Anxiety, and Stress Scale-21, DASS-21); work-related quality of life (Work-Related Quality of Life Scale, WRQoL); resilience (Connor-Davidson Resilience Scale, CD-RISC); anxiety about the novel coronavirus (Coronavirus Anxiety Scale, CAS); and loneliness (UCLA Loneliness Scale, ULS). Participants from the psychiatric hospital (n = 94) were sampled during the easing of restrictions after the first wave in Ontario, and participants from the acute care hospital (n = 146) were sampled during the height of the second wave in Ontario.Results:Data showed that HCPs from the acute care hospital and psychiatric hospital reported similar scores on the psychometric scales. There were also no significant differences in psychometric scale scores between medical disciplines at the acute care hospital. Among all HCPs, being a nurse predicted better quality of life (p = 0.01) and greater stress resilience (p = 0.031).Conclusion:These results suggest that HCPs' psychological symptoms are similar across the hospital settings sampled. Compared to other HCPs, nurses may show a unique resiliency to the pandemic. We suggest that emergencies such as the COVID-19 pandemic have a pervasive effect on HCPs. It is important to address HCPs' mental health needs in terms of crisis management and improve resilience among all HCPs during the inter-crisis period before a new challenge arrives.
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