Browsing by Author "Noel, Melanie Elizabeth"

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    Adolescent Dating Violence and Healthcare Interventions: A Systematic Scoping Review
    (2024-07-30) Vijh, Ruchi; Exner-Cortens, Deinera Marea; Madigan, Sheri; Noel, Melanie Elizabeth
    Adolescent dating violence (ADV) is a significant public health problem globally. Experiencing ADV is associated with several short- and long-term physical and psychological adverse health outcomes. Therefore, it is crucial to implement prevention and intervention strategies to address ADV in settings that serve adolescents. One natural point of contact is healthcare settings, as adolescents may present to these settings due to health concerns related to ADV exposure. Thus, healthcare providers are well-positioned to engage in ADV prevention and intervention strategies. However, little is known about the state of the science for how adolescent healthcare providers can participate in ADV prevention and intervention approaches, as well as the potential barriers healthcare providers may face when incorporating such strategies into their practice. To advance understanding, a systematic scoping review was conducted to summarize current evidence on 1) ADV prevention and intervention strategies in healthcare settings, and 2) healthcare provider perspectives on implementing these strategies. This review included peer-reviewed articles published in English from any time until September 2023. After excluding duplicates, the search yielded 5786 articles, 11 of which met the inclusion criteria and were included in this review. Overall, there were only a few studies on ADV preventive interventions designed for implementation in various healthcare settings. Common barriers identified to implementing ADV prevention and intervention strategies included limited time, training, and resources. Facilitators of implementation included ADV response protocols or guidelines and working in collaborative teams. This systematic scoping review demonstrates that further research is needed to develop and evaluate ADV prevention and intervention strategies in healthcare settings, and to understand barriers to implementing these strategies.
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    Choosing the Right Model of Care Together: Informing an Equitable, Patient-Oriented Decision Aid for In-Person vs Virtual Care of Pediatric Chronic Pain
    (2024-09-17) Marbil, Mica Gabrielle Aragon; Birnie, Kathryn Ann Manson; Noel, Melanie Elizabeth; McArthur, Brae Anne; Metcalfe, Amy Lynn
    Background. Pediatric chronic pain management can occur virtually or in-person, but youth with chronic pain and their families may not be involved in decisions about treatment delivery. Decision aids can supplement shared decision-making, a collaborative decision-making approach between patients and health professionals, and promote patient involvement. To inform the development of a decision aid for in-person versus virtual pediatric chronic pain care, this study sought to understand decision-making practices for in-person versus virtual care (part A) and glean desired decision aid features (part B) from patients’ (youth and caregivers) and health professionals’ experiences. Methods. In part A, an online survey on virtual care and decision-making practices was sent to international pediatric pain clinics. Main findings were descriptively summarized. In part B, patients and health professionals completed an online demographics survey and a semi-structured interview on virtual care decision-making experiences to inform decision aid features. Reflexive thematic analysis described common themes. Results. In part A, 67 clinic responses were included. Virtual care constituted <25% of overall pediatric chronic pain management. Families were reported to play the largest role in decisions. Top factors influencing decision-making included new referrals, patient demographics and location, and patient values and preferences. Most clinics did not evaluate in-person versus virtual care decisions. In part B, 11 patients (5 youth, 6 caregivers) and 15 health professionals participated. Four main themes were generated from health professionals, suggesting that the decision aid should: 1) contextualize the individual patient; 2) promote patient engagement and adherence to care; 3) support clinician characteristics and values; and 4) contextualize the decision-making encounter. Three themes created from patient perspectives guide the decision aid to: 1) communicate patient needs and preferences; 2) facilitate navigation of the healthcare system; and 3) build partnership in a paternalistic system. Discussion. Decision-making for in-person versus virtual pediatric chronic pain management is not always shared. Patients and health professionals have individual preferences for decision-making processes. The future decision aid prototype should consider the unique contexts surrounding health professionals and patients to best support decision-making needs.