"Building a More Inclusive Blood System in Canada": A Mixed-Methods Evaluation of a Workshop to Guide Medical Students to Develop as Health Advocates Through Advancing Health Equity in Blood Product Donation for Gay, Bisexual, and Queer Men

Introduction: Competent and socially responsible physicians require a range of abilities other than medical expertise to effectively meet the healthcare needs of the people they serve, including health advocacy skills. The CanMEDS framework for physician competency outlines that, as Health Advocates, physicians work to determine and understand patient and community needs, speak on behalf of others when required, and support the mobilization of resources to effect change. Although recognized as essential for medical trainees to develop, health advocacy is challenging to teach and assess. Here, we describe the development and evaluation of a workshop to support Canadian medical students to develop as health advocates through advancing health equity in blood product donation for gay, bisexual, and other men who have sex with men (gbMSM) in Canada. Methods: We developed a workshop for a Canadian medical student audience, "Building a more inclusive blood system in Canada", consisting of an online module followed by a virtual facilitated discussion group. The online module (available at stemcellclub.ca/training) outlined blood and stem cell donation in Canada for gbMSM, starting from the historical policies and the context in which they were first put in place, to today's policies and where future policies may lie (Fig. A). The module also presented content from a national campaign in Canada to engage gbMSM as stem cell donors (stemcellclub.ca/savingliveswithpride). The discussion group supported participants to reflect on donation policies for gbMSM and their consequences, and discuss how medical students can concurrently advocate for gbMSM and patients in need of blood products. A facilitator guide was developed and facilitator training was provided. A pre- and post- test was administered to participants to assess knowledge transfer. Quantitative and qualitative analyses were employed to evaluate participants' perspectives on the impact of the workshop on their development as health advocates. Results: From 10/2020-7/2021, workshops were hosted at 8 medical schools across Canada. 104 medical students from across Canada participated, of whom 65 (63% response rate) completed a pre- and post- workshop survey. 26 (40%) of survey respondents were male, 22 (34%) identified as LGBTQ+ (10 gay, 9 bisexual, 3 other), and 52% were non-Caucasian (from 9 different ancestral groups). 44 (68%) were in the first and 16 (25%) in second years of medical school. Post-workshop, mean scores on a 6-question stem cell donation knowledge test improved from 33% to 79% (p<0.001, Fig B), and 88% felt the workshop prepared them to discuss blood and stem cell donation for gbMSM with others. 98% strongly agreed/agreed the workshop supported their development as health advocates (Fig C), including the abilities to: advocate for patients beyond the clinical environment (83%); work with patients (88%) or communities and populations (74%) to address and identify determinants of health that affect them and their access to care; respond to the needs of communities or populations by advocating with them for system-level change (83%); improve clinical practice by applying a process of continuous quality improvement to disease prevention and health promotion activities (79%); and contribute to a process to improve the health of a community or population they will serve (90%). 94% felt that the workshop should be incorporated into medical curricula. 39 medical students participated in focus groups to share their perspectives on the workshop. (42% male, 37% LGBTQ+ identified, 76% non-Caucasian; 53% in first year of medical school). Qualitative analysis identified rich examples of participant development as health advocates through their participation in the workshop (Fig D). Conclusion: We present the perspective of a national cohort of medical students in Canada that their participation in a workshop on advancing health equity in blood product donation for gbMSM contributed to their development as health advocates. This workshop is a model for teaching health advocacy to medical students and is relevant to medical educators and curriculum developers. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Development and Evaluation of a Library of TikToks to Support Recruitment of Committed Hematopoietic Stem Cell Donors from Needed Demographic Groups

Introduction TikTok is a rapidly growing social media platform that allows users to develop and share short videos. We hypothesized that a library of videos developed through TikTok (TikToks) would support the recruitment of committed hematopoietic stem cell donors from needed demographic groups (i.e. young, male, from diverse ancestries). Methods Members of the community of practice (CoP) in stem cell donor recruitment in Canada (facebook.com/groups/stemcellclub) were activated to develop TikToks. Training was provided during e-meetings of the CoP (8/2020, 1/2021, 5/2021) and in a video published online (stemcellclub.ca/training), highlighting the principles of effective TikTok design. These principles included the use of engaging hooks, music, and calls to action; short duration (< 30s); high educational value; and appeal to diverse donors. The training also outlined how to: record content, adjust clip lengths, apply audiovisual effects, and share across social media platforms. A CoP TikTok committee was formed to develop and review TikToks prior to publication. Following launch, we evaluated stakeholder perspective on these TikToks and the impact 1) across social and traditional media and 2) on eligible donors' knowledge and attitudes towards donation. Results Between 9/2020-7/2021, a network of TikTok channels was launched by CoP members, including a national donor recruitment TikTok library (tiktok.com/@stemcellclub). A total of 217 TikToks were produced across these channels (median length 17s, range 4-52s), covering a range of educational topics, designed for use in specific recruitment campaigns, and featuring unique video effects (Fig. A). The TikToks accumulated over 234,000 Views, 42,000 Likes, 3,000 Comments, and 14,200 Shares on TikTok, were republished by Canadian media outlets (e.g. CBC [twitter.com/cbcnewsbc/status/1361511367426080773], CTV News [ctvnews.ca/health/meet-the-women-hoping-to-recruit-more-stem-cells-donors-from-black-communities-1.5314038, ctvnews.ca/health/pride-month-tiktok-drive-encourages-stem-cell-donations-from-gay-bi-men-1.5475113], Victoria News [vicnews.com/news/most-black-canadians-wont-find-a-stem-cell-donor-in-time-this-group-is-working-to-change-that]) and were highlighted by major medical organizations (e.g. Canadian Blood Services [blood.ca/en/stories/meet-stem-cell-club, blood.ca/en/stories/stem-cell-club-volunteers-aim-save-lives-pride-month-campaign], American Association of Blood Banks [aabb.org/news-resources/news/article/2021/02/01/twitter-tiktok-aabb-virtual-journal-club-assesses-use-of-multimedia-resources-for-donor-recruitment]). 33 CoP members from 6 provinces across Canada, with a median of 2 years of recruitment experience, completed a post-launch survey. The majority felt that TikToks promote donation in an attention-grabbing way (94%), engage younger donors (100%), and teach key points in a short time period (94%). The majority were confident in their ability to make TikToks (63%), but felt they would benefit from additional training (63%). 46 eligible stem cell donors (from 12 different non-Caucasian ancestral groups; living in 5 provinces across Canada) completed surveys evaluating the impact of TikToks on their knowledge and attitudes towards donation. No participants were registered as donors and only four had a personal connection to an individual who needed a stem cell transplant. After being shown a series of TikToks, mean scores on a 6-question stem cell donation knowledge test improved from 59% to 73% (p=0.0012) (Fig. B); mean scores on a modified Simmons Ambivalence Scale decreased from 52% to 30% (p<0.0001) (Fig. C); and participants were more willing to register as donors (70% vs. 39%, p=0.0011). Participants reported that viewing TikToks positively impacted on their decision to register (87%), helped them understand stem cell donation (89%), and would help them talk about stem cell donation with friends/family (78%). Conclusions We report the first published experience using TikToks in a donor recruitment context. Our TikToks achieved significant social and traditional impact in a short period of time, and supported recruitment of committed stem cell donors from needed demographic groups. Our work is relevant to recruitment organizations worldwide seeking to modernize their recruitment approaches. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

The Impact of Pre-Apheresis Health Related Quality of Life on Peripheral Blood Progenitor Cell Yield and Donor's Health and Outcome: Secondary Analysis of Rdsafe and BMT CTN 0201

Introduction: The adverse events associated with hematopoietic stem cell donation have been extensively studied. There is an increasing literature linking psychological factors including stress, anxiety and depression to higher levels of inflammatory burden leading to poorer post-procedural outcomes including longer hospital stays and increased pain perception. Here, we aimed to evaluate whether pre-donation health related quality of life (HRQoL) markers predict toxicity profile and stem cell yield following stem cell donation in healthy donors. Methods: The study population included adult granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood stem cell (PBSC) related donors (RD) (n= 157) and unrelated donors (URD) (n=179) who were enrolled in Related Donor Safety Study (RDSafe) and Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0201 clinical trials. Pre-donation HR QoL was assessed using the Short-Form (SF-8) in RDSafe and SF-12 questionnaire in BMT CTN 0201 (higher score is better). Pain and toxicity were collected on study specific forms. The primary outcome was the incidence of skeletal pain on day 5 of G-CSF administration. The secondary outcomes were the incidence of skeletal pain and highest toxicity level across selected body symptoms at 1 month, 6 months and 1-year post-donation. Another secondary outcome included CD34+ per liter of blood processed (x10 6/L) on day 5 of G-CSF as a measure of collection yield. The association between pre-apheresis HRQOL measures and pain and acute toxicities was characterized using means and SDs and compared using the t-test. Association between HRQoL and cell yield was assessed using the Pearson correlation coefficient. RD and URD were analyzed separately. Results: URDs were younger than RDs (median age 35 vs. 63). A higher proportion of RDs were female (50% vs. 40%) and obese (41% vs. 35%). A higher proportion of RD PBSC donations required 2 days or more (44% vs 21%). More RDs were collected with lower volume procedures (<18L, 28% vs. 16%), and required a central line (28% vs. 11%). RDs were more likely to report pre-donation grade 1-2 pain (27% vs. 8%) and other toxicities (16% vs. 6%). The mean pre-donation physical component summary (PCS) and mental component summary (MCS) score of RDs were 54.5 (SD 7.0) and 55.1 (SD 5.8), respectively . In the univariate analysis (table 1), pre-donation lower PCS score of RDs was associated with significantly more grade 2-4 pain at 1 month (p=0.0038) and 1-year post-donation (p=0.0099) (Table 1). In multivariable analysis (table 2), pre-donation PCS remained significantly associated with grade 2-4 pain 1-month post-donation (p=0.0098). More specifically, RDs with pre-donation PCS scores in the higher quartile were less likely to experience pain compared with donors with PCS scores in the lower quartile (OR 0.1; 95% CI 0.01-0.83; p=0.005). There was also a trend toward increased grade 2-4 pain at 1-year post-donation among RDs with lower PCS score (p=0.0176). Other outcomes such as pain at day 5 of G-CSF, other toxicities at day 5 of G-CSF, 1 month, 6 months and 1-year post-donation were not associated with pre-donation PCS score. Similarly, there was no significant association between RD pre-donation MCS score and collection-related symptoms at any time point. The mean pre-donation PCS and MCS scores of URDs were 56.2 (SD 4.7) and 54.5 (SD 5.5), respectively . In a univariate analysis, there was no association between PCS score or MCS score and donation associated pain and toxicities at any time point post-donation. Due to low event rates, multivariable analysis was not performed in the URD setting. Based on the multivariable regression analysis, there was no correlation between pre-apheresis HRQoL score (PCS or MSC) and PBSC collection yield in either the RD or URD setting. Conclusion: Our study demonstrates that pre-donation QoL markers are significantly associated with the toxicity profile after PBSC donation in the RD setting as adult RD with lower pre-donation physical QOL experience increased levels of pain after a PBSC collection procedure. There were no such associations found in URD in this small sample. Our findings may help clinicians to identify donors at higher risk of pain with donation, and lead to personalized information and interventions (e.g. increased analgesia) for specific donors. Future study with a larger sample is required to validate the results. Figure 1 Figure 1. Disclosures Farhadfar: Incyte: Consultancy. Stefanski: Novartis: Honoraria. Pulsipher: Equillium: Membership on an entity's Board of Directors or advisory committees; Adaptive: Research Funding; Jasper Therapeutics: Honoraria. Shaw: mallinkrodt: Other: payments; Orca bio: Consultancy.

“It’s harder for the likes of us”: racially minoritised stem cell donation as ethico-racial imperative

How best are we to understand appeals to participate in a biomedical project that are based both on invoking shared racial identity, and on framing engagement as the clear moral course of action? Stem cell donor recruitment, which often focuses on engaging racially minoritised communities, provides useful insight into this question. This article proposes that it is not an essential mutual racial identity between the person asking and the person asked at play. Rather, it is the creative ‘doing’ of relatedness between people at the scale of race as well as family that coalesces into powerful appeals to participate. Through analysis of ethnographic, documentary and social media data, the paper argues that this work relies at least partly on framing donation as a duty of being part of a racialised community, which I describe here as an ethico-racial imperative, in which both race and responsibility become intertwined to compel participation in the biomedical project of donor registration.

A Study on Hematopoietic Stem Cell Donation Volunteer Retention between Swab Sampling Approach and Blood Sampling Approach: Evidence from Shanghai, China

The loss of hematopoietic stem cell donation (HSCD) volunteers is widespread worldwide. This study analyzed the distribution characteristics of volunteer retention between the swab sampling approach and blood sampling approach. The Shanghai branch of the China Bone Marrow Donation Program conducted a telephone follow-up with 18,963 volunteers to understand volunteer retention. Multiple logistic regression was used to analyze the distribution characteristics of volunteer retention between two different sampling approaches, and a forest plot was used to observe the distribution trend. Only 32.37% of the volunteers could be contacted, and the loss of volunteers was severe. The volunteer retention is influenced by sampling approaches and demographic characteristics, and Shanghai natives, the highly educated, and students had better retention. The volunteer retention of the swab group was better among young people and technicians, while the volunteer retention of the blood sample group was lower among public officials and workers, and the volunteer retention in the blood sample group was more significantly affected by changes in population characteristics. To enhance the stability of volunteers, managers should improve the contact channels and frequency, expand the ratio of stable volunteers, strengthen volunteer education in the process of collecting blood samples, and respect individuals’ willingness.

Should the BCRA1/2-mutations healthy carriers be valid candidates for hematopoietic stem cell donation?

It’s still not clear whether the mutational status of BRCA-mutated healthy hematopoietic stem cells (HSCs) donors could have an impact on the engraftment. Comparing the studies present in literature, we focused on the correlation between BRCA mutations and the development of hematological malignancies and Fanconi anemia (FA); then, we explored HSCs types, frequencies, and functions in the presence of BRCA mutations, as well as the reconstitution of hematopoiesis after chemotherapy and radiation treatments. The role of BRCA mutations in the FA showed a possible involvement in the onset of the disease; the mutation carriers, indeed, did not show any sign of the typical phenotype of the FA. BRCA mutational status can be considered as a risk factor for hematological malignancies, but only for secondary malignancies and/or in the presence of bone marrow stress factors. Currently we don’t know if a conditioning regimen could be compensated by BRCA mutated HSCs, even if murine models tried to show the possible differences between fully mutated, haploinsufficient and normal HSCs. Thus, given the downregulating effect of the mutations on hematopoiesis, it could be questionable to use the HSCs of a BRCA-mutated donor in the presence of another available donor with the same compatibility.

A NHS Foundation Trust v MC [2020] EWCOP 33: Revisiting Best Interests and ‘Altruistic’ Incapacitous Stem Cell Donation

In A NHS Foundation Trust v MC, the Court of Protection revisits the question of whether adults should be allowed to act as bone marrow or peripheral blood stem cell donors if they lack decision-making capacity. This case note explores the positive and problematic implications of the case based on points that were raised in the judicial reasoning that specifically relate to i) practical implications concerning the key players in this environment, ii) the risk analysis within the best interest determination, iii) altruism and iv) the wider context as it relates to minor donors who lack capacity.

Donor–Recipient Story in Allogeneic Hematopoietic Stem Cell Transplantation

Patients with a variety of blood, immune, and metabolic disorders may require an allogeneic hematopoietic stem cell transplant as part of their treatment. However, over 70% of these patients do not have a matched sibling donor and require an alternative donor, such as a matched unrelated donor. We present a multi-part story of a Canadian stem cell recipient who underwent transplantation for treatment of refractory chronic myelogenous leukemia, and the matched unrelated donor who saved his life. The story segments feature excerpts from interviews with the donor and the recipient, along with representative images of both storytellers. The excerpts were optimized for publication on social media and were arranged to build a story arc that parallels the journey of the donor and recipient together. This donor-recipient story may serve as a resource to help raise awareness about stem cell donation and to encourage eligible individuals to register as donors. The story is one of several developed by Why We Swab, a library of stories in stem cell donation in Canada (Facebook, Twitter, and Instagram; @WhyWeSwab) to support the recruitment of committed unrelated donors.