Browsing by Author "Roach, Pamela"
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- ItemOpen AccessA logic framework for addressing medical racism in academic medicine: an analysis of qualitative data(2024-04-15) Roach, Pamela; Ruzycki, Shannon M.; Lithgow, Kirstie C.; McFadden, Chanda R.; Chikwanha, Adrian; Holroyd-Leduc, Jayna; Barnabe, CherylAbstract Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.
- ItemOpen AccessAnti-Indigenous bias of medical school applicants: a cross-sectional study(2022-09-19) Roach, Pamela; Hernandez, Santanna; Carbert, Amanda; Jalil, Rabiya; Panaccione, Remo; Ruzycki, Shannon M.Abstract Background Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias. Methods All applicants to a single university in the 2020–2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating ‘cold/unfavourable’ to 100, indicating ‘warm/favourable’) and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students. Results There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80–100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37–55), and had mild implicit preference for European faces (− 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful. Conclusions Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.
- ItemOpen AccessCentering Indigenous Voices to Inform the Delivery of Culturally-Appropriate Mental Wellness Services(2021-06-28) Zaretsky, Lisa; Katrina, Milaney; Roach, Pamela; El-Lahib, YahyaColonization and ongoing colonial policies and practices have shaped a mental healthcare system rooted in racism. A systemic lack of awareness and response to the transhistorical impacts of colonization have resulted in the perpetuation of mental wellness services that are not culturally-appropriate. Utilizing an anti-colonial theoretical framework, the purpose of this study was to explore if Indigenous peoples were receiving mental wellness supports that were responsive to their needs. A storytelling methodology was used with five participants from permanent supportive housing (PSH) buildings to share their experiences of mental wellness including homelessness and alcohol use. The stories revealed profound resistance to ongoing colonization. Further analysis of stories identified the absence of available supports, cultural connection, and supportive staff relationships in PSH buildings. Together, these results suggest participants are not receiving mental wellness supports that are culturally-appropriate. Using the Truth and Reconciliation Calls to Action as a framework for change, agencies can actively work towards providing culturally-appropriate mental wellness supports by: 1) increasing the availability of supports; 2) ensuring access to culture and connection; 3) re-evaluating hiring policies; 4) providing ongoing training; and 5) transforming to relationship-based care. Ultimately, this shift towards anti-colonial mental wellness services will result in disrupting colonial systems, policies, and practices; however, without the leadership and self-determination of Indigenous peoples themselves, there will be no real change in the provision of culturally-appropriate services.
- ItemOpen AccessExploring Transitions in Care Among Patients with Head and Neck Cancer: A Multimethod Study(2023-12-20) Kersen, Jaling Kathleen; Sauro, Khara; Ronksley, Paul; Roach, Pamela; Chandarana, ShamirIntroduction: Head and Neck Cancers (HNC) are the 6th most common cancer worldwide. Due to the complex nature of HNC, treatments are multifaceted and focus on diverse anatomical structures. As such, patients with HNC experience many Transitions in Care (TiC), which occur when patients transfer between healthcare providers, institutions, and settings. Although a necessary component of patient care, TiC represent a vulnerable point in the journey and are associated with compromised patient safety, decreased patient satisfaction, and increased healthcare costs. However, our understanding of TiC among patients with HNC is lacking. The objective of this multimethod study was to understand TiC among patients with HNC and identify opportunities to improve care for patients with HNC. Methods: This multimethod study consisted of two phases: a retrospective cohort study and qualitative description. Phase I was a retrospective population-based cohort study that characterized the number and type of TiC that patients with HNC experienced using routinely collected populations-based administrative health databases including the Alberta Cancer Registry, Discharge Abstract Database, the National Ambulatory Care Reporting System, and Physician Claims between January 1, 2012, to December 1, 2019. Both patient demographic and TiC variables were dichotomously coded and described using descriptive statistics. In Phase II, semi-structured interviews were used to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Two independent reviewers used an inductive approach to thematically analyze the semi-structured interview transcripts. Results: In Phase I, there were 2,208 patients with HNC who were mostly male (71.1%), classified as Stage IV HNC at diagnosis (62.4%) and had two or more tumours (91.3%). Patients with HNC often underwent multiple treatment modalities (average: 1.5), with the most common treatment transitions being from surgery to radiotherapy (29.7%). Many patients with HNC were admitted to the hospital and emergency department during the study period, averaging 2.0 hospital admissions and 13.2 emergency departments per patient during the study period. Patients with HNC also experienced many TiC between healthcare providers, with the highest number of physician visits being to general practitioners (average= 62.24 per patient). In Phase II, there were 16 semi-structured interviews conducted with ten patients with HNC and six healthcare providers. The experiences of patients with HNC and their healthcare providers revealed three interconnected themes related to TiC: 1) Navigating the Healthcare System (subthemes include: Head and Neck Cancer Care Complexities, Disrupted Continuity of Head and Neck Cancer Care, and Healthcare System Pressures), 2) Relational Head and Neck Cancer Care (subthemes include: Patient Expectations during Transitions in Care, Feeling Valued as a Head and Neck Cancer Patient and Healthcare Provider Roles and Responsibilities) and 3) System and Individual Impact of Transitions in Care (subthemes include: Impact of Resource-intensive Nature of TiC and the Impact of Transitions in Care on Quality of Care). Conclusions: In sum, this study identifies the challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within HNC. This study suggests TiC may have an impact on the quality of care and provides crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of care during TiC within this patient population. These findings also identified potentially feasible interventions for further exploration, such as shared decision-making, telehealth, or a patient navigator within HNC care.
- ItemOpen AccessThe Role of Sport in Promoting Wellness Among Indigenous Youth: A Qualitative Study for Policy and Practice(2023-09-25) Mortimore, Emma; Henderson, Rita; Crowshoe, Lynden (Lindsay); Roach, Pamela; Murry, AdamThis work builds on a multi-year community outreach platform led by the Indigenous, Local and Global Health Office at the University of Calgary’s Cumming School of Medicine, to investigate how sport may be supportive of wellness in Indigenous youth. It builds on literature that has shown the promise of sport as a population-level approach for promoting wellness among youth. For this qualitative study, we interviewed eight Indigenous individuals involved in sport, either in their youth or in a leadership capacity as an adult, asking: how do sports support Indigenous youth wellness? Two rounds of iterative thematic analysis were conducted, first investigating how participants described wellness, then assessing how sport acted to promote their concepts of wellness. Participants described the concept of wellness through four core components: i) belonging to something greater than yourself, ii) developing identity, iii) overcoming adversity, and iv) belonging and contributing to a community of support. In investigating how sport supports wellness, one major theme emerged that crosscut all others: connectedness. This manifested at the personal, interpersonal, and wider social levels in the lives of participants. This work culminates in considering how existing frameworks for youth wellbeing can be expanded to better include Indigenous perspectives. Findings are oriented to policy action in the Cumming School of Medicine, as well as aim to influence change of practice for those working with Indigenous youth in sport more broadly.
- ItemOpen AccessUnderstanding the Knowledge, Perception, and Experiences of Patients about Precision Medicine and Biobanking; A Qualitative Study(2022-02) Haque, Mohammad; Page, Stacey; Santana, Maria; Roach, Pamela; Dubyk, Alexander-Sandy; Syme, RachelChronic Kidney Disease (CKD) patients’ knowledge, perception, and experiences surrounding Precision Medicine (PM) and biobanking were explored in this study. This study used a qualitative methodology. Data was collected by individual virtual interviews utilizing a semi-structured open-ended interview guide. Framework analysis was used on the resulting transcripts. Methodological rigor was achieved through credibility, reliability, and reflexivity. Four themes were identified concerning CKD patients’ knowledge, perception, and experiences of PM: benefits, concern, perceived barriers to implementing PM, and preferences on the informed consent model. Another four themes were identified regarding CKD patients’ knowledge, perception, and experiences of biobanking: benefits, concern about biobank research or donation of samples, factors that influence participation in biobank research, and ownership of donated samples. This unique study investigated the knowledge, perception, and experiences of CKD patients about PM and biobanking. The study results may help support programs and provisions that aim to overcome challenges that hinder a patient’s participation in PM and biobank research and consequently amplify patient engagement and awareness in PM and biobank research studies. In the end, the information gained from this study will add value to future PM and biobank research and clinical initiatives.
- ItemOpen AccessUnderstanding the lived experiences of people with myasthenia gravis: a narrative-based study(2022-04) Crooks, Rachel; Roach, Pamela; Haines-Saah, Rebecca; Lashewicz, Bonnie; Atkins, ChloëMyasthenia gravis (MG) is a neuromuscular disease that is well-studied from a clinical perspective, but research often excludes the perspectives of people with MG. This study explored the lived experience of MG with two specific aims: 1) to investigate how people with MG narrate their lived experiences, and 2) to explore how narratives of lived experience may disrupt and/or reinforce common clinical narratives of MG and their reproduction. Utilizing a critical disability studies framework, the study specifically investigated how participants internalized or resisted ableism in the telling of their stories. Informed by narrative inquiry methodology, unstructured interviews were used to co-create a narrative with four participants. Each narrative highlighted a unique experience of MG, where participants spoke of dealing with the rarity of the disorder, feelings about worthiness and value, challenges while managing social relationships, and navigating ongoing uncertainty inherent to the experience of MG. People tended to tell their stories based on dominant understandings of disability and illness; where disability is an individual problem to be overcome. These narratives describe the lived experience of people with MG beyond a symptomatic or clinical perspective, using critical disability studies to account for the social and political contexts in which these narratives are located.
- ItemOpen AccessUnderstanding virtual primary healthcare with Indigenous populations: a rapid evidence review(2023-03-29) Fitzpatrick, Kayla M.; Ody, Meagan; Goveas, Danika; Montesanti, Stephanie; Campbell, Paige; MacDonald, Kathryn; Crowshoe, Lynden; Campbell, Sandra; Roach, PamelaAbstract Background Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. Methods We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? Results We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. Conclusion These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.