Views of leaders in under-represented and equity-denied communities on organ and tissue donation in Nova Scotia, Canada, in light of the Human Organ and Tissue Donation Act: a qualitative descriptive study.

OBJECTIVE: To explore the views of underserved and equity-denied communities in Nova Scotia, Canada, regarding organ and tissue donation and deemed consent legislation. DESIGN: A qualitative descriptive study was undertaken, employing both interviews and focus groups. SETTING: The province of Nova Scotia, Canada-the first jurisdiction in North America to implement deemed consent legislation for organ and tissue donation. PARTICIPANTS: Leaders of African Nova Scotian, Lesbian, Gay, Bisexual, Trans, Queer, Two Spirit (LGBTQ2S+) and Faith-based communities (Islam and Judaism) were invited to participate (n=11). Leaders were defined as persons responsible for community organisations or in other leadership roles, and were purposively recruited by the research team. RESULTS: Through thematic analysis, four main themes were identified: (1) alignment with personal values as well as religious beliefs and perspectives; (2) trust and relationships, which need to be acknowledged and addressed in the context of deemed consent legislation; (3) cultural competence, which is essential to the roll-out of the new legislation and (4) communication and information to combat misconceptions and misinformation, facilitate informed decision-making, and mitigate conflict within families. CONCLUSIONS: Leaders of African Nova Scotian, LGBTQ2S+ and Faith-based communities in Nova Scotia are highly supportive of deemed consent legislation. Despite this, many issues exemplify the need for cultural competence at all levels. These findings should inform ongoing implementation of the legislation and other jurisdictions considering a deemed consent approach to organ and tissue donation.

Risk Stratification and Cancer Follow-Up: Towards More Personalized Post-Treatment Care in Canada.

After treatment, cancer survivors require ongoing, comprehensive care to improve quality of life, reduce disability, limit complications, and restore function. In Canada and internationally, follow-up care continues to be delivered most often by oncologists in institution-based settings. There is extensive evidence to demonstrate that this model of care does not work well for many survivors or our cancer systems. Randomized controlled trials have clearly demonstrated that alternate approaches to follow-up care are equivalent to oncologist-led follow-up in terms of patient outcomes, such as recurrence, survival, and quality of life in a number of common cancers. In this paper, we discuss the state of follow-up care for survivors of prevalent cancers and the need for more personalized models of follow-up. Indeed, there is no one-size-fits-all solution to post-treatment follow-up care, and more personalized approaches to follow-up that are based on individual risks and needs after cancer treatment are warranted. Canada lags behind when it comes to personalizing follow-up care for cancer survivors. There are many reasons for this, including difficulty in determining who is best served by different follow-up pathways, a paucity of evidence-informed self-management education and supports for most survivors, poorly developed IT solutions and systems, and uneven coordination of care. Using implementation science theories, approaches, and methods may help in addressing these challenges and delineating what might work best in particular settings and circumstances.

Factores psicosociales que influyen en los procesos de vinculación, adherencia e inclusión a los procesos de resocialización, por parte de los habitantes de calle de la ciudad de Medellín / Psychosocial factors that influence the processes of linkage, adhesion and inclusion to the processes of resocialization, by the homeless people of the city of Medellín

En este estudio se describen los factores psicosociales que influyen en los procesos de vinculación, adherencia e inclusión de los habitantes de calle a los programas de atención y de este modo hacer visibles características que podrían tomarse en cuenta para el diseño e implementación de estos sistemas de atención y políticas públicas. El estudio tiene un diseño cualitativo y método etnográfico. El objetivo general que se propuso fue Describir los factores psicosociales que influyen en los procesos de vinculación, adherencia e inclusión de los habitantes de calle a programas y procesos de recuperación y resocialización. Como resultados, se describen las categorías de Factores Psicosociales, Procesos de inclusión y Redes de apoyo, que abordan los factores de protección y riesgo de la población. Entre los factores de riesgo más predominantes para la habitanza en calle, externos al sujeto, están la violencia intrafamiliar, pobreza, asistencialismo, conflicto intraurbano y el trato de los operadores terapéuticos. Entre los factores de riesgo internos al sujeto, se hallaron el consumo, abuso y dependencia de sustancias psicoactivas, discapacidad física o cognitiva, ruptura de vínculos familiares y sociales, auto-exclusión. Entre los factores de protección encontrados, se pueden identificar algunos externos como las redes familiares, institucionales y de pareja. A nivel subjetivo, el factor espiritual y los sistemas de creencias parecen tener un rol preponderante.

In this study we describe the psychosocial factors that influence the bonding, adherence and inclusion processes of street people to care programs and in this way make visible characteristics that could be taken into account for the design and implementation of these systems attention and public policies. The study has a qualitative design and ethnographic method. The general objective that was proposed was to describe the psychosocial factors that influence the linking processes, adherence and inclusion of street people to programs and processes of recovery and re-socialization. As results, the categories of Psychosocial Factors, Inclusion Processes and Support Networks are described, which address the protection and risk factors of the population. Among the most prevalent risk factors for street habitancy, external to the subject, are intrafamily violence, poverty, assistance, intra-urban conflict and the treatment of therapeutic operators. Among the risk factors internal to the subject, were the consumption, abuse and dependence of psychoactive substances, physical or cognitive disability, rupture of family and social ties, self-exclusion. Among the protection factors found, some external factors can be identified, such as family, institutional and couple networks. At the sub- jective level, the spiritual factor and belief systems seem to have a preponderant role.