Patient-reported health outcomes of SARS-CoV-2-tested patients presenting to emergency departments: a propensity score-matched prospective cohort study.

OBJECTIVE: This study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients controlling for seasonal effects. STUDY DESIGN: This was a retrospective cohort study. METHODS: This study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2-negative controls for every SARS-CoV-2-positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. RESULTS: We included 1170 SARS-CoV-2-positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (ß = -7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (ß = -5.4; 95% CI: -6.3, -4.5). CONCLUSION: Physical health, assessed by PCS, was similar between matched SARS-CoV-2-positive and SARS-CoV-2-negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.

USING PROFESSIONAL VIDEO INTERPRETATION TO ENHANCE PATIENT EDUCATION FOR RADIATION THERAPY PATIENTS WITH LIMITED ENGLISH PROFICIENCY

Purpose: The purpose of patient education is to maintain or improve health throughout the cancer care journey, from diagnosis to treatment and beyond. COVID-19 has undeniably created a shift in the delivery of cancer care education with the transition to virtual care and enforcement of visitor restrictions. This has hindered equity and inclusion for patients with limited English proficiency (LEP) as they rely heavily on family members to be ad hoc interpreters. Language barriers are linked to less health education, lower interpersonal care and lower patient satisfaction. At the time of the project, professional over-the phone interpreters were used infrequently. The purpose of this project was to investigate alternate methods to enhance patient education for patients with LEP. Materials and Methods: A needs assessment was completed by surveying staff about their perspectives on current LEP education and interpreter use in the department, and patients to determine their comfort in communicating with radiation therapists and their preferred interpretation methods. After assessing the results of the needs assessment and examining interpretation options, professional video interpretation was implemented in February 2020. Interpreter usage has been tracked and post-implementation evaluation conducted with staff and patients. Results: According to the staff survey (n=69), professional over-the-phone interpreters were used least at 8% compared to other methods due to inconvenience and time constraints. Although family members (59%) and bilingual staff (62%) are most commonly used for convenience, decreased accuracy and workflow disruption were significant concerns. In addition, of the 34 staff that are fluent in a second language, only 6% stated that they were ‘very comfortable' in interpreting medical conversations. Patient surveys (n=12) indicated that 67% of LEP patients were not aware that the hospital offered free interpretation services. When asked if they were comfortable asking questions or discussing side effects with their therapists, only 36% and 40% were very comfortable, respectively. When asked which interpretation method they would most prefer for daily interactions, patients and staff showed similar results with bilingual staff members as most preferred (35%), professional face-to-face interpreters (30%), family member or friend (22%) and professional over-the-phone interpreters (13%). With the implementation of professional video interpretation, professional interpreter usage increased two-fold after COVID-19 visitor restrictions were enforced. Positive feedback has been received by both patients and staff. Conclusions: The needs assessment analysis revealed that ad hoc interpretation was used most frequently and preferred by both patients and staff. However, challenges can arise if family members also have LEP or are unable to accompany the patient, and if staff do not speak the patient's language. During COVID-19, the implementation of an institutional live-video interpretation service showed a two-fold usage increase since visitor restrictions were introduced. LEP patients have been more comfortable asking questions and staff have complimented the convenience and accessibility of the video interpreters. Video interpretation is a convenient tool that allows radiation oncology staff to use professional interpreters to communicate with patients virtually face-to-face and accurately provide education in their preferred language.

Conducting an international curriculum review meeting in the age of COVID-19

The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.