use of digital tablets eases the way to compassionate care during the COVID-19 pandemic

Objective: A patient communication program was implemented as a response to hospitals visiting restrictive policies during the COVID-19 pandemic. The aim of the program was to facilitate communication between patients and families, mainly through the use of digital tablets; thus program performance was evaluated by selecting the number of calls performed, the average call time, and the percentage of patients that used the program more than once. Methods: A communication service for hospitalized patients who did not have access to a personal electronic device or were unable to use their electronic device was launched at different MUHC hospitals. A dedicated team of re-deployed employees was available to help patients connect with their loved ones using a hospital tablet or telephone. Results: A total of 806 calls were performed between April and November 2020. Eighty one percent of the calls were performed during the non-visitors policy implementation, being video calls preferred over phone calls. The average call time was 15 min, 34% of the patients had a video call with their loved one more than once and 40% of the calls were performed in the intensive care unit. Conclusion: The patient communication program can be described as a new delivery model of compassionate care. It was effective, helped reduce patients’ isolation and met the needs of family members and caregivers during the hospital non-visitors policy directed by the Ministère de la Santé et des Services Sociaux de Québec during the Covid-19 pandemic.

Patient and Citizen Participation in the Identification of Ethical Considerations Aiming to Address Uncertainty in the Evaluation of Promising Interventions in a Pandemic Context

Since the beginning of the COVID-19 pandemic, numerous studies have been conducted to identify interventions that could contribute to alleviating the burden it has caused. The Institut national d'excellence en santé et en services sociaux (INESSS) has played a key role in informing the government of Québec regarding the evaluation of specific pandemic-related interventions. This process took place in a context characterized by a sense of urgency to assess and recommend potential interventions that could save lives and reduce the effects of the disease on populations and healthcare systems, which increased the pressure on the regulatory agencies leading these evaluations. While some of the interventions examined were considered promising, results from COVID-19 studies often led to uncertainty regarding their efficacy or safety. Regulatory agencies evaluating the value of promising interventions thus face challenges in deciding whether these should be made available to the population, particularly when assessing their benefit-risk balance. To shed light on these challenges, we identified underlying ethical considerations that can influence such an assessment. A rapid literature review was conducted in February 2021, to identify the main challenges associated with the benefit-risk balance assessment of promising interventions. To reinforce our understanding of the underlying ethical considerations, we initiated a discussion among various social actors involved in critical thinking surrounding the evaluation of promising interventions, including ethicists, clinicians and researchers involved in clinical or public health practice, as well as patients and citizens. This discussion allowed us to create a space for exchange and mutual understanding among these various actors who contributed equally to the identification of ethical considerations. The knowledge and perspectives stemming from the scientific literature and those consulted were integrated in a common reflection on these ethical considerations. This allowed patients and citizens, directly affected by the evaluation of pandemic-related interventions and the resulting social choices, to contribute to the identification of the relevant ethical considerations. It also allowed for reflection on the responsibilities of the various actors involved in the development, evaluation, and distribution of promising interventions in a setting of urgency and uncertainty, such as that brought about by the COVID-19 pandemic.

Development of a self-reported reflective tool on advanced access to support primary healthcare providers: study protocol of a mixed-method research design using an e-Delphi survey

IntroductionTimely access is one of the cornerstones of strong primary healthcare (PHC). New models to increase timely access have emerged across the world, including advanced access (AA). Recently in Quebec, Canada, the AA model has spread widely across the province. The model has largely been implemented by PHC professionals with important variations; however, a tool to assess their practice improvement within AA is lacking. The general objective of this study is to develop a self-reported online reflective tool that will guide PHC professionals’ reflection on their individual AA practice and formulation of recommendations for improvement. Specific objectives are: (1) operationalisation of the pillars and subpillars of AA; (2) development of a self-reported questionnaire; and (3) evaluation of the psychometrics.Methods and analysisThe pillars composing Murray’s model of AA will first be reviewed in collaboration with PHC professional and stakeholders, patients and researchers in a face-to-face meeting, with the goal to establish consensus on the pillars and subpillars of AA. Leading from these definitions, items will be identified for evaluation through an e-Delphi consultation. Three rounds are planned in 2020–2021 with a group of 20–25 experts. A repository of recommendations on how to improve one’s AA practice will be populated based on the literature and enriched by our experts throughout the consultation. Median and measures of dispersions will be used to evaluate agreement. The resulting tool will then be evaluated by PHC professionals for psychometrics in 2021–2022.Ethics and disseminationThe Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre Scientific Research Committee approved the protocol, and the Research Ethics Board provided ethics approval (2020-441, CP 980475). Dissemination plan is a mix of community diffusion through and for our partners and to the scientific community including peer-reviewed publications and conference presentations.

Telework in a pandemic context: protocol of a participatory study on the effects of teleworking conditions on the well-being and social participation of workers

IntroductionAlthough several authors have been interested in the well-being and social participation of teleworkers in the context of the COVID-19 pandemic, it appears that most of the recommendations issued are based on literature reviews or expert opinions; yet few authors have documented the perspectives of the workers. The aim of this study is to explore workers’ perspectives of teleworking in the context of the COVID-19 pandemic regarding the effects on their well-being and social participation.Methods and AnalysisUsing a participatory study protocol involving the collaboration of a community organisation defending workers’ rights, the first step will be to conduct focus groups to qualitatively describe workers’ perspectives of their teleworking conditions. Then, an online questionnaire will be administered to a large pool or workers to quantitatively explore the influence of individual, organisational and environmental variables on the well-being and social participation of workers. The thematic and statistical analyses of the data collected will indicate successful practices to be adopted by workers and organisations. These successful practices will be validated by workers through a Technique for Research of Information by Animation of a Group of Experts group and will serve as concrete tools to better support workers’ participation in teleworking.Ethics and disseminationThe approval of the research ethics board of the Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale has been obtained. Findings will be shared with various stakeholders including workers, employers, insurers and unions. Findings will be disseminated in webinars, peer-reviewed journals and lectures.

EXperienceS and aTtitudes towards Agitated behaviours in Traumatic brain injury in the Intensive Care unit patients (EXSTATIC): a protocol for an interprofessional mixed-method study

IntroductionAgitation and violent behaviours are common conditions developed by patients with acute traumatic brain injury (TBI) in intensive care units (ICUs). Healthcare professionals caring for these patients have various tools to manage these behaviours, but lack of a formal protocol to assess and manage them makes caring for these patients a challenge. Moreover, safety may often be compromised for both ICU professionals and patients encountering such situations. The EXperienceS and aTtitudes towards Agitated behaviours in Traumatic brain injury in the Intensive Care unit patients (EXSTATIC) study aims to explore the experiences and attitudes of ICU nurses and other ICU healthcare professionals on the management of agitated behaviours in patients with acute TBI.Methods and analysisEXSTATIC is a multicenter mixed methods convergent study exploring experiences and attitudes of ICU healthcare professionals caring of agitated patients with TBI. The study includes three qualitative methods (observation, semistructured interviews and focus groups) and one quantitative method (retrospective cohort). The integration of the different methods will be done using sequential steps of the research and by the integration of results for each step. Qualitative data will be evaluated following a thematic analysis derived from a grounded theory approach. Quantitative data will be analysed using descriptive statistics. Qualitative and quantitative results will be combined in a convergent interactive interpretative design. Gender and race perspective will be integrated in collection, analysis and interpretation of data.Ethics and disseminationThis study has been approved by the Centre intégré universitaire de santé et de services sociaux du nord de l’île de Montréal (CIUSSS-NÎM) Research Ethics Board. The findings will be disseminated locally with ICU staff and health managers, international peer-reviewed journals, a PhD dissertation, and national and international conferences. The knowledge derived from this study is key in the development of clinical protocols to manage agitation and related behaviours in patients with TBI and designing further interventional studies targeting this specific problematic.Trial registration numberNCT04741399.