ABSTRACT
Background: Individuals with autoimmune infammatory rheumatic diseases (AIRDs) have an increased baseline risk of severe COVID-19 infection. Intersection of inequity factors may result in more severe adverse effects through influencing opportunities for health. We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs. Objectives: The objective of this study is to assess how health equity is considered in studies of COVID-19 vaccination studies in individuals with AIRDs. Methods: All studies (N=19) from an ongoing Cochrane living systematic review on the effects of COVID-19 vaccination in people with AIRDs were included. We identifed inequity factors using the PROGRESS-Plus framework which stands for Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. Age, multimorbidity, and health literacy were also assessed as 'Plus' factors. We applied the framework to assess equity considerations in relation to differences in COVID-19 baseline risk, description of participant characteristics, controlling for confounding factors, subgroup analysis and applicability of study fndings. RESULTS: All nineteen studies are cohort studies that followed individuals with AIRDs after COVID-19 vaccination. Two articles (11%) described differences in baseline risk for COVID-19 across age. All nineteen studies described participant age and sex, with race/ethnicity and multimorbidity described in four (21%) and occupation in one (5%). Seven studies (37%) controlled for age and/or sex as confounding factors. Eleven studies (58%) conducted subgroup analysis across at least one PROGRESS-Plus factor, most commonly age. Eight studies (42%) discussed at least one PROGRESS-Plus factor in interpreting the applicability of results, most commonly age (32%), then race/ethnicity and multimorbidity (11%). Conclusion: It is unknown whether COVID-19 vaccine studies on individuals with AIRDs are applicable to populations experiencing inequities, as key inequity factors beyond age and sex have little to no reporting or analysis. Future COVID-19 vaccine studies should report social characteristics of participants consistently, facilitating informed decisions about the applicability of study results to the population of interest.
ABSTRACT
Background: The vaccination of healthcare (HC) and long-term care (LTC) workers against COVID-19 has been a top priority, given their high risk of exposure and close contact with vulnerable populations. Despite the demonstrated effectiveness of vaccines, high levels of hesitancy among workers were observed in the first few months of the COVID-19 vaccine rollout in Canada. Despite our understanding of why HC and LTC workers might be vaccine hesitant, the evidence around the measurable impact of various education strategies to improve vaccine confidence is limited. This scoping review intended to minimize the gap between existing research and practice regarding the approach to and efficacy of education interventions to improve COVID-19 vaccine confidence among HC and LTC staff. We aimed to explore and characterize both informal and formal educational interventions delivered during the pandemic to support COVID-19 vaccine confidence. Methods: In consultation with a medical information scientist we searched 5 databases including, Ovid MEDLINE and Web of Science, as well as grey literature. We considered all study designs and reports. We chose to include a breadth of sources to ensure our review could capture preliminary evidence, as well as more experiential experiences of COVID-19 vaccine education delivery. Articles were screened by three reviewers independently. The data were charted and results described narratively. Results: After screening 1,917 titles and s and 72 fulltext articles, 7 articles met our inclusion criteria. In addition, we included 6 papers from our grey literature search. Of these, 46% (n=6) included formal evaluations of their educational interventions. The following themes were identified: educational content, delivery structure, targeting specific communities, and personal connections. Conclusions: Our review suggests that interventions should consider leveraging community (patient, cultural, religious) partnerships when both developing and facilitating COVID-19 vaccine education. Train the trainer approaches with recognized community members could be of value as trust and personal connections were identified as a facilitator throughout the review.
ABSTRACT
Background: AML is a haematologic cancer primarily affecting older people (median age 68 at diagnosis). Prognosis is poor, with median survival ranging from 2 to 10 months from diagnosis, depending on patient health, age, and treatment path. Some patients described struggling with uncertainty about the future, but it is unclear how this differs across patients and treatment paths. Aims: This study explored the experiences of AML patients (≥65 years old, not receiving intensive chemotherapy), their close relatives, and independent clinicians. Specifically, patient expectations for the future and how these varied by treatment path and by time since diagnosis were investigated. Methods: A total of 28 AML patients (aged 65-83;median 74), 25 relatives, and 10 clinicians from the US, UK, and Canada each took part in a 60-minute, semi-structured telephone interview. Open-ended questions were used to elicit spontaneous content, followed by focused questions when needed. Results: Patients had diverse treatment histories: 13 no treatment, 14 with experience of non-intensive chemotherapy (NIC) including 3 who discontinued treatment, and 1 on best supportive care (BSC). At time of interview the mean time since diagnosis was 5 (range 2 to 9) months for patients with no treatment experience, and 8 (range 2 to 19) months for those with treatment experience. The BSC patient was diagnosed 9 months prior to interview. Patients discussed positive and negative expectations for the future related to: physical functioning;treatment;life expectancy;ability to do hobbies, spend time with family, and go on vacation. In the no treatment group, there was evidence that expectations about the future became more negative over time. Few patients (n=4/13) recalled having negative expectations about the future at diagnosis, while most (n=10/13) did at time of interview. In contrast, patients with treatment experience appeared to have increasingly positive expectations. Most of these patients (n=11/14) recalled negative expectations when diagnosed, whereas at interview most (n=9/14) felt hopeful about future events. Further, of patients with treatment experience, almost all those diagnosed ≥6 months prior to interview had positive expectations about their future (n=6/7), while under half of those diagnosed <6 months prior (n=3/7) did. Clinicians (n=7/10) further highlighted that patient expectations changed over time depending on treatment success. Additionally, patients (n=15/28) and relatives (n=15/25) discussed feeling uncertain throughout the AML journey, reporting unknowns around life expectancy, what they would be able to accomplish, and future plans. Uncertainty was a consistent experience regardless of treatment history, with similar proportions of patients not on treatment (n=7/13) and those with NIC experience (n=7/14) reporting the sentiment. Additionally, recently interviewed patients (n=7/13) and relatives (n=7/10) noted that the ongoing COVID-19 pandemic contributed to experiences of uncertainty and difficulties planning for the future. Summary/Conclusion: There were key differences between patients not on treatment and those with experience of NIC, as patients with treatment experience demonstrated more hope for the future. Regardless, uncertainty is a key element of the AML journey. For some patients, this was exacerbated by the COVID-19 pandemic. These findings highlight the importance of ensuring all patients are provided with emotional and spiritual support to help them process their diagnosis and plan for the future, both during this pandemic and beyond.