Background and context: Ongoing advances have been made in the conceptualization and operationalization of palliative and end-of-life care (PEOLC) (e.g., palliative approaches to care, early identification of people who would benefit from palliative care). In addition, Canada has been a leader in PEOLC research and continues to have an internationally recognized research community. However, many Canadians continue to experience unnecessary pain and suffering at the end of life and receive care inconsistent with their goals and preferences. Within this context, the Canadian Cancer Research Alliance (CCRA) sought to develop a national research framework to guide Canada's cancer research funders in response to their strategic priority to improve the patient experience and quality of life for all cancer patients. Aim: To develop and implement a national framework and recommendations to enable funders to capitalize on existing research strengths and build capacity to address unmet needs to advance the field and broaden the scope, beyond its historical affiliation with advanced cancer, to include PEOLC for all those living and dying with life-limiting conditions. Strategy/Tactics: The framework's development was informed by multiple approaches, including: a strategic literature review; an analysis of PEOLC research funding in Canada from 2005-13; and an online survey and key informant interviews from the broader stakeholder community. Program/Policy process: A working group of CCRA member representatives and palliative care experts met regularly to provide guidance and feedback to a consultant who synthesized the data and formulated recommendations. In total, > 200 stakeholders (e.g., patients, caregivers, researchers, volunteers, practitioners, decision-makers, and policy-makers) provided input through the survey and interviews. Outcomes: The Pan-Canadian Framework for Palliative and End-of-Life Research was released March 2017. It emphasizes priorities for research funding across three broad themes: 1) Transforming models of care; 2) Patient and family centredness; and 3) Ensuring equity. The identified research priorities are underpinned by four building blocks: capacity building; knowledge, synthesis, exchange, and implementation; data access and standardization; and research network development. What was learned: Successful implementation of the framework's recommendations requires strong leadership from champions within the community. The formation of the Pan-Canadian Palliative Care Research Collaborative led by palliative care clinician-researchers, in response to the identified need for a research network, is an example of an early success resulting from release of the framework. Continued efforts are needed to ensure ongoing uptake of the framework's recommendations. CCRA members have commenced planning to identify next steps for joint action.
BackgroundCancer research is essential in evaluating the safety and effectiveness of emerging cancer treatments, which in turn can lead to ground-breaking advancements in cancer care. Given limited research funding, allocating resources in alignment with societal burden is essential. However, evidence shows that such alignment does not typically occur. The objective of the present study was to provide an updated overview of site-specific cancer research investment in Canada and to explore potential discrepancies between the site-specific burden and the level of research investment.MethodsThe 10 cancer sites with the highest mortality in 2015—which included brain, female breast, colorectal, leukemia, lung, non-Hodgkin lymphoma, ovary, pancreas, prostate, and uterus—were selected for the analysis. Information about site-specific research investment and cancer burden (raw incidence and mortality) was obtained from the Canadian Cancer Research Survey and Statistics Canada’s cansim (the Canadian Socio-Economic Information Management System) respectively. The ratio of site-specific research investment to site-specific burden was used as an indicator of overfunding (ratio > 1) or underfunding (ratio < 1).ResultsThe 3 cancer sites with the highest research investments were leukemia, prostate, and breast, which together represented 51.3% of 2015 cancer research funding. Conversely, the 3 cancer sites with the lowest investments were uterus, pancreas, and ovary, which together represented 7.8% of 2015 research funding. Relative to site-specific cancer burden, the lung, uterus, and colorectal sites were consistently the most underfunded.ConclusionsObserved discrepancies between cancer burden and research investment indicate that some cancer sites (such as lung, colorectal, and uterus) seem to be underfunded when site-specific incidence and mortality are taken into consideration.
← Objective Over the past decade, clinical studies and clinical practice guidelines have suggested the use of higher small solute clearance targets for patients on peritoneal dialysis (PD). This study asks whether these recommendations have translated into changes in clinical prescription of PD. ← Study Design Data were collected annually from 1996 to 1999 on all prevalent dialysis patients in 24 Canadian centers, accounting for approximately 40% of the Canadian chronic dialysis population. Approximately a third of these patients were on PD. Full details of each patient's prescription were recorded, with particular attention to dwell volumes and frequency of exchanges for continuous ambulatory PD (CAPD) and to total treatment volumes and day dwells for automated PD (APD). The most recent Kt/V and creatinine clearance values available were recorded for each patient and the overall results for each year were compared to present treatment recommendations. ← Setting 24 university- and community-based hospitals. ← Results From 1996 to 1999, the use of APD, relative to CAPD, grew from 14% to 28% of all PD patients. Among CAPD patients, the proportion using dwell volumes greater than 2 L rose from 14% to 32%, and the proportion doing more than 4 dwells per day rose from 16% to 28%. The mean daily volume of prescribed fluid for CAPD patients increased from 8.3 to 9.1 L. As a result, the proportion of patients achieving a weekly Kt/V above 2.0 rose from 54% to 72%, and those receiving a Kt/V less than 1.7 fell from 22% to 10%. For creatinine clearance, those exceeding 60 L per week rose from 63% to 73%. For APD, the mean treatment volume rose from 11.8 L in 1996 to plateau at about 13.4 L in 1998 and 1999. However, the proportion of patients receiving more than 1 day dwell grew from 31% in 1998 to 40% in 1999, and the proportion that were “day dry” fell from 25% to 17%. For APD, the proportion of patients with a Kt/V above 2.0 rose from 67% to 77%, and with a creatinine clearance above 60 L, from 62% to 70%. The proportion with no recent clearance value recorded fell during the course of the study, from 45% to 27%. ← Conclusion There was a marked change in PD prescription practices in Canada during the second half of the 1990s. This occurred in response to clinical studies and publication of guidelines. There is room for further improvement, especially with respect to the proportion of patients that did not have regular clearance measurements made.
This article describes two workshops on health-promoting policy change, developed and delivered to more than 1,000 public and community health practitioners across one Canadian province. The workshops were designed to increase knowledge about the process of policy change and provide opportunities for skill development. Three basic instructional methods--minilectures, individual pen-and-paper exercises, and small-group activities--were used. Workshops were delivered using a host organization arrangement, meaning organizations willing to host workshops could do so if they provided the venue and invited members of other organizations in the community. Initial evaluations indicate that practitioners find the workshops useful and that many have integrated the information into their day-to-day work. To the author's knowledge, no other workshops of this nature have been delivered in this systematic way.
Background and context: Across all cancer types, two-thirds of Canadians diagnosed with cancer today will survive long-term, reflecting great progress in cancer detection and treatment. Many survivors, however, will experience substantial and long-term impacts of their diagnosis and treatment. Within this context, the Canadian Cancer Research Alliance (CCRA) sought to inform the cancer research funding community on how, and what kinds of research are needed, to enable research that will make a difference to patients as they move from treatment to the posttreatment phase. Aim: To develop and implement a national framework and recommendations to enable coordinated and strategic action among cancer research funders that advances cancer survivorship research in Canada in ways that improve survivors' care and experiences. Strategy/Tactics: Multiple approaches were used to inform framework development: a strategic literature review; an analysis of cancer survivorship research funding from 2005-13; and an online survey and key informant interviews from the broader stakeholder community. An Expert Panel and Patient Advisory Committee were also engaged to provide guidance and feedback. Program/Policy process: Over the course of one year, the project team and a working group of CCRA members met regularly to steer framework development. This involved activities such as developing data collection approaches and tools, reviewing data and emerging findings, and translating findings into priority areas and recommendations. In total, > 200 Canadian and international stakeholders provided input through the survey and interviews. Outcomes: Released March 2017, the Pan-Canadian Framework for Cancer Survivorship Research provides four recommendations for cancer research funders: 1) ensure ongoing and meaningful involvement of cancer survivors; 2) align funding calls with existing needs and potential for impact; 3) create opportunities for the translation of research into practice and policy; and 4) build and maintain infrastructure and expertise to advance research. Specific research priorities were emphasized across three research domains: survivors' experiences and outcomes; late and long-term effects; and models of care. The priorities ranged from investigating the mechanisms of late/long-term effects to conducting intervention research to improve psychosocial outcomes, prevent and ameliorate late effects, and improve integration of follow-up care. What was learned: A broad range of stakeholders came together to develop a national framework to maximize the impact of shared targeted research investment in cancer survivorship research. Survivors' voices were key to agreeing on definitional issues of survivorship, identifying priority research areas, and ultimately lending credibility to the resulting framework. Implementation of the framework is the next step of work for CCRA members. Planning has commenced on identifying an initial priority for joint action.
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