Browsing by Author "Brown, Janine"

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Open Access
Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study
(Elsevier, 2020) Brown, Janine; McDonald, Meghan; Besse, Cheryl; Manson, Patti; McDonald, Reid; Rohatinsky, Noelle; Singh, Madeline
Open Access
Care considerations in a patient-and family-centered medical assistance in dying program
(SAGE Publications, 2020) Brown, Janine; Goodridge, Donna; Harrison, Averi; Kemp, Jordan; Thorpe, Lilian; Weiler, Robert
Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patients, families, and providers were used to assess opportunities to enhance patient-and family-centered care (PFCC) in this program.
Open Access
Completion of Medical Certificates of Death after an Assisted Death: An Environmental Scan of Practices
(Longwoods, 2018-11) Brown, Janine; Thorpe, Lilian; Goodridge, Donna
Policies and practices have been developed to operationalize assisted dying processes in Canada. This project utilized an environmental scan to determine the spectrum of assisted death reporting practices and medical certificate of death (MCD) completion procedures both nationally and internationally. Findings suggest medically assisted dying (MAiD) is represented on the MCD inconsistently nationally and internationally. Related factors include the specifics of local assisted death legislation and variations in death-reporting legislation, variation in terminology surrounding assisted death and designated oversight agency for assisted dying reporting.
Open Access
Factors contributing to practitioner choice when declining involvement in legally available care: A scoping protocol
(BMJ, 2018-07-27) Brown, Janine; Goodridge, Donna; Thorpe, Lilian; Chipanshi, Mary
As legislation addressing medical treatments continues to evolve, there are several circumstances (eg, abortion, assisted dying) in which health practitioners may choose to not provide legally available care options. It is not always clear what underlies practitioner choice, as some research has suggested non-participation in care provision is not always due to an ethical abstention but may represent other factors. This results in tension between a practitioner’s right to refrain from practices deemed morally objectionable by the practitioner, and the care recipient’s right to access legally available treatments. The aim of this systematic scoping review is to identify the current knowledge regarding all the factors influencing practitioner’s choices when declining involvement in legally available healthcare options.
Open Access
Factors influencing practitioners’ who do not participate in ethically complex, legally available care: scoping review
(BioMed Central (BMC), 2021-09-28) Brown, Janine; Goodridge, Donna; Thorpe, Lilian; Hodson, Alexandra; Chipanshi, Mary
Evolving medical technology, advancing biomedical and drug research, and changing laws and legislation impact patients’ healthcare options and influence healthcare practitioners’ (HCPs’) practices. Conscientious objection policy confusion and variability can arise as it may occasionally be unclear what underpins non-participation. Our objective was to identify, analyze, and synthesize the factors that influenced HCPs who did not participate in ethically complex, legally available healthcare.
Open Access
“I Am Okay With It, But I Am Not Going to Do It”: The Exogenous Factors Influencing Non-Participation in Medical Assistance in Dying
(SAGE Publications, 2021-07-08) Brown, Janine; Goodridge, Donna; Thorpe, Lilian; Crizzle, Alexander
Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients’ locations. This research explored the factors that influenced HCPs’ nonparticipation in formal MAID processes and their needs to support this emerging practice area. Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.
Open Access
Medical Assistance in Dying in health sciences curricula: A qualitative exploratory study
(Canadian Medical Education Journal, 2020-09-03) Brown, Janine; Goodridge, Donna; Thorpe, Lilian
This paper offers insight into (1) the driving and restraining forces impacting the inclusion of medical assistance in dying (MAID) in health sciences curricula, (2) the required resources for teaching MAID, and (3) the current placement of MAID in health sciences curricula in relation to end-of-life care concepts.
Open Access
Medical Assistance in Dying: Patients', Families', and Health Care Providers' Perspectives on Access and Care Delivery
(Mary Ann Liebert, 2020) Brown, Janine; Goodridge, Donna; Harrison, Averi; Kemp, Jordan; Thorpe, Lilian; Weiler, Robert
Open Access
Systematic implementation and evaluation of an app-based community platform for assessing pain in long-term care facilities
(Faculty of Graduate Studies and Research, University of Regina, 2022-07) Tran, Vivian; Hadjistavropoulos, Thomas; Gordon, Jennifer; Beshai, Shadi; Brown, Janine
Pain is under-assessed and under-addressed among older adults living in long-term care (LTC) facilities. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) is a validated assessment tool for health professionals to assess pain in residents with dementia. A tablet app, based on the PACSLAC-II, has been shown to have clinical utility. This study involved the systematic implementation and evaluation of a new community platform that works in conjunction with an updated PACSLAC-II app. The community platform is comprised of (a) a quality indicator (QI) feature, which allows health care professionals to view and share their unit QI scores (e.g., frequency of resident assessments) with other units; and (b) a resource community portal (CP) feature aimed at facilitating user interaction and continuing education. The objectives of this study were to (1) evaluate whether pain Qis (e.g., frequency and timeliness of pain management interventions) improved with the use of the app (and each feature) compared to the LTC unit’s regular pain assessment practices; (2) evaluate the impact of the use of the PACSLAC-II app and each of the new features on health care professionals’ self-reported stress and burnout levels, and; (3) obtain the perspectives of health care professionals on the app and its specific features through semi-structured interviews. Based on the job-demand resource model, it was anticipated that LTC units assigned to use the app and both features would see the most gains in QI scores, reduced staff stress, and staff satisfaction with the app. This would be followed by units that were assigned to the app with only one feature, and lastly by units that had access to the basic app with no additional features. For the purposes of hypothesis testing, a minimum of 25% improvement in QI scores was considered to reflect meaningful change. This study employed a mixed methods multiple-baseline design across several LTC facilities. Eleven LTC facilities participated in this study and were randomly assigned to one of five conditions (App only, App + QI, App + CP, App + QI + CP, App + CP + QI). Complementing the unit data, 34 health care professionals completed self-report questionnaires and 32 participated in semi-structured interviews. QI data revealed improvements in QI scores compared to baseline regardless of experimental condition. Contrary to hypotheses, however, regression analyses showed that demographic data and utilization of the associated websites did not predict stress and burnout scores. Thematic analysis of staff interviews showed that a majority of participants expressed a preference for using the app as opposed to a paper version of the PACSLAC-II due to reasons such as the app’s ability to provide useful information (i.e., resident pain graphs), increased data security, as well as its user-friendly interface and increased convenience. The overall increase in QI scores observed in the implementation period suggests that the utilization of the PACSLAC-II may be effective and feasible in improving pain assessment practices in LTC facilities. At the same time, QI gains were not maintained during a follow up period, likely related to unusually high competing demands on staff due to the COVID-19 pandemic. Nonetheless, the results of this study strongly support benefits of using the app version of the PACSLAC-II, although use of the extra features were not shown to confer additional advantages to frontline staff. As pointed out by some participants, the QI feature might prove more useful for facility administrators monitoring overall facility performance than to frontline nursing staff.
Open Access
“What is right for me, is not necessarily right for you”: The endogenous factors influencing non-participation in medical assistance in dying
(SAGE Publications, 2021-05-03) Brown, Janine; Goodridge, Donna; Thorpe, Lilian; Crizzle, Alexander
Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients’ locations. This research explored the factors that influenced HCPs’ nonparticipation in formal MAID processes and their needs to support this emerging practice area. Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.