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This registration contains the protocol for a scoping review looking at how the social determinants of health are have been integrated into quality indicators for colorectal cancer surgery.

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Background: Multiple sclerosis (MS) is an autoimmune disease that is often treated with multiple medications. Managing multiple medications, also known as polypharmacy, can be challenging for persons with MS. Toolkits are instructional resources designed to promote behaviour change. Toolkits may support medication self-management for adults with MS, as they have been useful in other populations with chronic conditions. Objective: The main purpose of this review was to identify and summarize medication self-management toolkits for MS, as related to the design, delivery, components, and measures used to evaluate implementation and/or outcomes. Methods: A scoping review was conducted following guidelines by JBI. Articles were included if they focused on adults (18 years or older) with MS. Results: Six articles reporting on four unique toolkits were included. Most toolkits were technology-based, including mobile or online applications, with only one toolkit being paper-based. The toolkits varied in type, frequency, and duration of medication management support. Varying outcomes were also identified, but there were improvements reported in symptom management, medication adherence, decision-making, and quality of life. The six studies were quantitative in design, with no studies exploring the user experience from a qualitative or mixed-methods design. Conclusions: There is limited research on medication self-management toolkits among adults with MS. Future development, implementation, and evaluation mixed-methods research are needed to explore user experiences and overall design of toolkits.

Cancer screening is an integral component of primary care, and providers can play a key role in facilitating screening. While much work has focused on patient interventions, less focus has been given to primary care provider (PCP) interventions. In addition, cancer screening disparities for patients experiencing marginalization exist and are likely to worsen if not addressed. The objective of this scoping review is to report on the range, extent and nature of PCP interventions for addressing cancer screening with marginalized patients.

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Early detection of breast cancer through screening reduces breast cancer mortality. The benefits of screening must also be considered within the context of potential harms (e.g., false positives, overdiagnosis). Furthermore, while breast cancer risk is highly variable within the population, most screening programs use age to determine eligibility. A risk-based approach is expected to improve the benefit-harm ratio of breast cancer screening programs. The PERSPECTIVE I&I (Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation) project seeks to improve personalized risk assessment to allow for a cost-effective, population-based approach to risk-based screening and determine best practices for implementation in Canada. This commentary describes the four inter-related activities that comprise the PERSPECTIVE I&I project. 1: Identification and validation of novel moderate to high-risk susceptibility genes. 2: Improvement, validation, and adaptation of a risk prediction web-tool for the Canadian context. 3: Development and piloting of a socio-ethical framework to support implementation of risk-based breast cancer screening. 4: Economic analysis to optimize the implementation of risk-based screening. Risk-based screening and prevention is expected to benefit all women, empowering them to work with their healthcare provider to make informed decisions about screening and prevention.

IntroductionPharmacists are often included on interprofessional primary care teams. Their inclusion has led to improved clinical outcomes, reduced harms, and reduced costs to the healthcare system. However, there are concerns they are underutilized and have unexplained variations in their roles. This study explored how the role of the pharmacist is negotiated in a primary care team setting. This presentation focuses on how organizational procedures can support role negotiation. Aims Objectives Theory or MethodsFive teams were recruited for a multiple case study completed using Yin’s approach. Using Goffman’s theories of self and impression management, negotiation of the pharmacist’s role was explored. Goffman’s theory outlines how individuals (e.g., actors) interact to achieve the object (e.g., role) of interactions. In this case study, how interprofessional team members negotiated to create the pharmacists’ role, including both tasks and their delivery was examined. Both interview data and documents were analysed using the Qualitative Analysis of Leuven to create themes. Data was analyzed both deductively and inductively to characterize negotiation and its enablers. Highlights or Results or Key FindingsThree cases were fully recruited. Participants described role negotiation as a smooth process without conflict. Often participants described pharmacists as willing to take on new tasks and deliver whatever was asked of them. In cases with strong organizational procedures, the pharmacists’ role was more proactive and less dependent on other team members (e.g., physicians). Organizations with strong procedures tended to negotiate more tasks for the pharmacist to perform independently and allow for direct access by patients. From document analysis, it was identified that organizations who documented their strategic goals and measured their progress towards these goals had more examples of maximizing the pharmacists’ role. They also discussed how the different roles on the team provided value to the team and contributed to their vision. Additionally, known organizational procedures provided a pathway for the pharmacist to ask for role changes, if needed. ConclusionsOrganizations that had more formal procedures discussed concerted efforts to maximize human resources within their organization and aligned them within their community. By organizations supporting or leading role negotiation, the pharmacist was able to better contribute to the organization, and independently and equitably deliver patient care. Implications for applicability/transferability sustainability and limitations Although the results are specific to the cases, they demonstrate an ability for “top-down” policies or programs to be effective for pharmacists’ role change. This may help to effectively and efficiently negotiate new tasks and share best practices across organizations as a mechanism for role change.

Purpose: The purpose of this scoping review was to map the scope of the literature on polypharmacy among individuals with spinal cord injury or dysfunction (SCI/D). Material and methods: Five electronic databases were searched for literature published between January 1990 and July 2018. The following keywords were searched using Boolean operators, wild cards, proximity operators and truncations: spinal cord injuries, multiple medications, polypharmacy. The initial search identified 1,459 articles; 1,098 remained after deduplication. Following the title and abstract screen, 81 full-texts were reviewed, and 18 met all of the eligibility criteria for inclusion in the review. Results: Of the 18 studies identified, less than half defined polypharmacy. Definitions varied in the types and number of medications. Older age, higher level of injury and greater severity of injury were factors related to polypharmacy. Negative clinical outcomes, such as drug-related problems and bowel complications were identified. Conclusions: This scoping review identified a paucity of research on polypharmacy post-SCI/D, highlighting a need for future research. To improve the state of knowledge, there is a need to better understand factors and clinical outcomes related to polypharmacy in persons with SCI/D and to explore experiences of persons with SCI/D, caregivers and clinicians relating to polypharmacy.Implications for rehabilitationPrescribers should be aware of the factors and negative clinical outcomes related to polypharmacy and spinal cord injuries/dysfunction, especially for patients with higher level and more severe injuries.Prescribers should work with their patients with spinal cord injuries/dysfunction to avoid inappropriate polypharmacy and to integrate appropriate alternatives to medications.Optimizing medication management should be a significant focus of spinal cord injury/dysfunction rehabilitation and research in order to develop targeted interventions that improve patient outcomes. Prescribers should be aware of the factors and negative clinical outcomes related to polypharmacy and spinal cord injuries/dysfunction, especially for patients with higher level and more severe injuries. Prescribers should work with their patients with spinal cord injuries/dysfunction to avoid inappropriate polypharmacy and to integrate appropriate alternatives to medications. Optimizing medication management should be a significant focus of spinal cord injury/dysfunction rehabilitation and research in order to develop targeted interventions that improve patient outcomes.

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