The Evidence Speaks Series is a recurring feature highlighting the latest in Advancing Health research. This series features summaries of select publications and is designed to keep media and the research community up to date with the Centre’s current research results in the health outcomes field.
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Technology integration appears beneficial in rural long-term care environments, but more work is needed
Chew H-J, Freeman S, Jackson P, Hemingway D, Klassen-Ross T, Martin-Khan M, Banner D. Technology use in long-term care during the COVID-19 pandemic: A qualitative study of paid employees’ experiences in Western Canada. Digit Health. Published online December 19, 2024.
Advancing Health Scientist Dr. Davina Banner spoke with 52 long-term care (LTC) home staff in northern and rural areas of Western Canada to understand the role and impact of technology during the COVID-19 pandemic. The interviews revealed a variety of new uses of technology in the rural LTC environment, including video conferencing to connect residents with their loved ones, and streaming services to support recreational activities, such as spiritual services. However, feedback indicated that some residents were not satisfied with the use of technology when connecting with loved ones; they were more interested in in-person connections. Furthermore, some accessibility barriers existed such as poor internet connection and lack of adequate support for using unfamiliar programs. Overall, this study highlights how technology can benefit LTC homes in rural and northern BC, while sharing some key areas where additional support is required to optimize the integration of technology in the LTC environment.
More support needed when making decisions about chronic pain management
Naye F, Légaré F, Cachinho C, Gérard T, Toupin-April K, Sasseville M, Paquette J-S, LeBlanc A, Gaboury I, Poitras M-E, Li LC, Hoens AM, Poirier M-D, Tousignant-Laflamme Y, Décary S. People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey. BMC Prim Care. 2024 Dec;25(1):424.
Most care for chronic pain is provided in primary care, though it is unclear how the decisional needs of chronic pain patients are met in this setting. Advancing Health’s Dr. Linda Li and Alison Hoens collaborated with a cross-Canada team to conduct a survey of adults living with chronic non-cancer pain to understand their needs when it comes to making decisions about their care. Of the 1649 survey respondents, 96.7 per cent faced at least one difficult decision in their care, whether that be related to day-to-day living or their diagnosis and treatment. A total of 48.8 per cent made that decision with a primary care physician, while 33.7 per cent of respondents experienced clinically significant decisional conflict, which is associated with decision delays, exiting active treatment, decision regret, and nervousness. When questioning what respondents would prefer if faced with the same difficult decision in the future, 75.7 per cent stated that they would prefer a collaborative role. This research highlights that people living with chronic pain in Canada would benefit from more support when making decisions about their care. The work could inform the development of interventions to implement shared decision-making, especially in primary care settings.
Significant gaps in kidney care access observed among vulnerable populations
Erickson RL, Kamath N, Iyengar A, Ademola A, Esezobor C, Lalji R, Hedin E, Arruebo S, Caskey FJ, Damster S, Donner J-A, Jha V, Levin A, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Disparities in kidney care in vulnerable populations: A multinational study from the ISN-GKHA. PLOS Glob Public Health. 2024 Dec;4(12):e0004086.
Using survey data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), Advancing Health Scientist Dr. Adeera Levin and colleagues described access and delivery of kidney replacement therapy (KRT) to vulnerable populations, such as children, the elderly, and refugees. KRTs include haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT). Clinicians, policymakers, and patient advocates across 167 countries or jurisdictions participated in the survey. Analyses showed the median prevalence of paediatric nephrologists was just 0.69 per million population compared with 10.8 per million in the adult population, with the prevalence increasing with country income levels. This corresponds to the finding that children had less access to KRTs in over half of the countries surveyed. Furthermore, refugees did not routinely have access to HD in 21 per cent, PD in 33 per cent, and KT in 37 per cent of countries, with reduced access being more likely in low-income countries. Testing of the elderly for chronic kidney disease was routine in 61 per cent of responding countries. In all, this study highlights significant gaps in kidney care access among vulnerable populations around the world, emphasizing the need for more government support, particularly in lower income countries, to address health inequities.
