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Abstract Background Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.

ÉNONCÉ DE POSITION DE L’ACIO/CANOSommaireLe vieillissement de la population constitue une nouvelle réalité pour les infirmières en oncologie du Canada. La variété et l’éventuelle complexité des besoins des patients âgés et des proches exigent une approche intégrative, globale et personnalisée.Pour prodiguer des soins de qualité aux adultes âgés atteints de cancer et bien accompagner les proches, les infirmières canadiennes en oncologie souhaitent miser sur les forces, favoriser l’accessibilité, optimiser les communications (en personne et en mode virtuel), soutenir la prise de décision quant au traitement, évaluer et prendre en compte diligemment les enjeux liés à l’âge, en plus d’assurer un travail d’équipe interprofessionnel et interdisciplinaire efficace, ainsi qu’une collaboration dynamique entre les professionnels de la santé offrant des soins de proximité et les prestataires de soins en oncologie.La pratique infirmière en oncologie est une composante clé de la qualité des soins. Au Canada, les infirmières en oncologie sont à l’écoute des préoccupations des patients et de leurs proches et défendent leur cause dans les équipes de soins et au-delà; elles optimisent également les soins en gérant les besoins liés à l’âge, en coordonnant les soins et en facilitant l’orientation des patients vers les bons services.Pour contribuer pleinement à la qualité des soins que reçoivent les adultes âgés, les infirmières canadiennes en oncologie ont besoin de soutien et de ressources dans les domaines de la pratique clinique, du leadership, de la formation, des politiques et de la recherche.

CANO/ACIO POSITION STATEMENTPosition SummaryThe aging population presents a new reality for Canadian oncology nursing care. The variation and potential complexity of the needs of older adults with cancer and their families requires integrative, comprehensive, and tailored approaches to care.Canadian oncology nurses envision quality care for older adults with cancer and their families that honors strengths, promotes accessibility of care and optimal communication (in-person and virtually), supports treatment decision making processes, proactively assesses and addresses age-related concerns, involves effective interprofessional and interdisciplinary teamwork, and ensures active collaboration among community and cancer care providers. Oncology nursing practice is key to this quality care. Canadian oncology nurses notice patient and family concerns; advocate for the patient and family within and beyond health care teams; and act to optimize care by managing age-related needs, facilitating referrals, and coordinating care.To contribute fully to quality of care for older adults with cancer, Canadian oncology nurses require support and resources in clinical practice, leadership, education, policy, and research.

Racial disparities in policing and recent high-profile incidents resulting in the deaths of Black men have ignited a national debate on policing policies. Given evidence that both police officers and Black men may be associated with threat, we examined the impact of perceived threat on support for reformed policing policies. Across three studies we found correlational evidence that perceiving police officers as threatening predicts increased support for reformed policing practices (e.g., limiting the use of lethal force and matching police force demographics to those of the community). In contrast, perceiving Black men as threatening predicted reduced support for policing policy reform. Perceived threat also predicted willingness to sign a petition calling for police reform. Experimental evidence indicated that priming participants to associate Black men with threat could also reduce support for policing policy reform, and this effect was moderated by internal motivation to respond without prejudice. Priming participants to associate police officers with threat did not increase support for policing policy reform. Results indicate that resistance to policing policy reform is associated with perceiving Black men as threatening. Moreover, findings suggest that publicizing racially charged police encounters, which may conjure associations between Black men and threat, could reduce support for policing policy reform.