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An embodied geography of disablement: chronically ill women's struggles for enabling places in spaces of health care and daily life.

https://arctichealth.org/en/permalink/ahliterature170167
Source
Health Place. 2006 Sep;12(3):345-52
Publication Type
Article
Date
Sep-2006
Author
Valorie A Crooks
Vera Chouinard
Author Affiliation
School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. crooksva@mcmaster.ca
Source
Health Place. 2006 Sep;12(3):345-52
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Arthritis
Chronic Disease
Demography
Disabled Persons - psychology
Female
Fibromyalgia
Humans
Interviews as Topic
Ontario
Abstract
Using data gathered from 18 interviews with women who have developed arthritic illnesses we illustrate how becoming a chronically ill woman is a geographically uneven process. By examining changes in the spatial configuration of everyday life, performances of the ill female self in places, and relations with places of life important to these women, such as the health care clinic and workplace, we show how women's capacities to struggle effectively for enabling identities are challenged. Further, we argue that embodying illness involves women and others, including doctors, assigning meanings to their changing material, lived and represented places in the world.
PubMed ID
16546699 View in PubMed
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An industry perspective on Canadian patients' involvement in medical tourism: implications for public health.

https://arctichealth.org/en/permalink/ahliterature134048
Source
BMC Public Health. 2011;11:416
Publication Type
Article
Date
2011
Author
Rory Johnston
Valorie A Crooks
Krystyna Adams
Jeremy Snyder
Paul Kingsbury
Author Affiliation
Department of Geography, Simon Fraser University, Burnaby, BC V5A 1S6, Canada. rrj1@sfu.ca
Source
BMC Public Health. 2011;11:416
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Canada
Female
Humans
Industry
Interviews as Topic
Male
Medical Tourism
Middle Aged
Patient Participation
Public Health
Abstract
The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health.
Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection.
Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients.
No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for a comprehensive public health response to medical tourism and its effects should be coupled with a clear understanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators as important stakeholders in medical tourism.
Notes
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PubMed ID
21627830 View in PubMed
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Assessing the suitability of host communities for secondary palliative care hubs: a location analysis model.

https://arctichealth.org/en/permalink/ahliterature152185
Source
Health Place. 2009 Sep;15(3):792-800
Publication Type
Article
Date
Sep-2009
Author
Jonathan Cinnamon
Nadine Schuurman
Valorie A Crooks
Author Affiliation
Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6. jca80@sfu.ca
Source
Health Place. 2009 Sep;15(3):792-800
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
British Columbia
Geographic Information Systems
Health Services Accessibility
Health services needs and demand
Humans
Models, Theoretical
Palliative Care
Professional Practice Location
Rural Population
Terminally ill
Abstract
An increased need for palliative care has been acknowledged world-wide. However, recent Canadian end-of-life care frameworks have largely failed to consider the unique challenges of delivery in rural and remote regions. In the Canadian province of British Columbia (BC), urban areas are well-served for specialized palliative care; however, rural and remote regions are not. This study presents a location analysis model designed to determine appropriate locations to allocate palliative care services. Secondary palliative care hubs (PCH) are introduced as an option for delivering these services in rural and remote regions. Results suggest that several BC communities may be appropriate locations for secondary PCHs. This model could be applied to the allocation of palliative care resources in other jurisdictions with similar rural and remote regions.
PubMed ID
19269241 View in PubMed
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Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

https://arctichealth.org/en/permalink/ahliterature134395
Source
BMC Public Health. 2011;11:335
Publication Type
Article
Date
2011
Author
Allison M Williams
Jeanette A Eby
Valorie A Crooks
Kelli Stajduhar
Melissa Giesbrecht
Mirjana Vuksan
S Robin Cohen
Kevin Brazil
Diane Allan
Author Affiliation
Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada.
Source
BMC Public Health. 2011;11:335
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Canada
Caregivers - psychology
Cost of Illness
Female
Humans
Interviews as Topic
Male
Middle Aged
Program Evaluation
Public Health
Terminal Care
Abstract
An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model.
As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework.
Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants.
This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.
Notes
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PubMed ID
21592383 View in PubMed
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Canada's Compassionate Care Benefit: views of family caregivers in chronic illness.

https://arctichealth.org/en/permalink/ahliterature166792
Source
Int J Palliat Nurs. 2006 Sep;12(9):438-45
Publication Type
Article
Date
Sep-2006
Author
Allison Williams
Valorie A Crooks
Kelli I Stajduhar
Diane Allan
S Robin Cohen
Author Affiliation
School of Geography and Earth Sciences, McMaster University, Burke Science Building, Room 343, 1280 Main Street West, Hamilton, Ontario, L8S 4K1. awill@mcmaster.ca
Source
Int J Palliat Nurs. 2006 Sep;12(9):438-45
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Canada
Caregivers - psychology
Chronic Disease
Compensation and Redress
Family - psychology
Humans
Abstract
Based on a pilot evaluation of Canada's recently introduced Compassionate Care Benefit (CCB), the purpose of this paper is to highlight the experiences of family caregivers caring for people with non-malignant advanced chronic illness.
Using Patton's (1997) utilization-focused evaluation approach, 25 telephone interviews were conducted with three groups of family caregivers: those who had successfully applied for the CCB; those who were unsuccessful in their applications; those who had never applied for the benefit.
The CCB has a number of limitations, particularly for caregivers of patients diagnosed with non-malignant advanced chronic illness. The central limitations are: difficulties associated with accurate prognostication; limited definition of "family member"; insufficient length of the funding period.
By modelling similar programmes internationally, such as those in Sweden, Norway, and the Netherlands, Canada would likely find the CCB to have greater relevance and accessibility to Canadian caregivers, particularly those caring for people with non-malignant advanced chronic illness.
PubMed ID
17077803 View in PubMed
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Canadian family doctors' roles and responsibilities toward outbound medical tourists: "Our true role is ... within the confines of our system".

https://arctichealth.org/en/permalink/ahliterature256910
Source
Can Fam Physician. 2013 Dec;59(12):1314-9
Publication Type
Article
Date
Dec-2013
Author
Rory Johnston
Valorie A Crooks
Jeremy Snyder
Shafik Dharamsi
Author Affiliation
Simon Fraser University, Geography, 8888 University Dr, Burnaby, BC V5A 1S6. rrj1@sfu.ca.
Source
Can Fam Physician. 2013 Dec;59(12):1314-9
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Aftercare
Attitude of Health Personnel
British Columbia
Continuity of Patient Care
Family Practice
Focus Groups
Humans
Medical Tourism
Patient Care Planning
Physician's Role
Abstract
To explore how Canadian family doctors understand their roles and responsibilities toward patients who seek health care abroad.
Six focus groups were held with family doctors across British Columbia to explore their experiences with and perspectives on outbound medical tourism. Focus groups were digitally recorded, transcribed, and subsequently thematically coded to discover common issues and themes across the entire data set.
Focus groups were held with family doctors in 6 cities in British Columbia that provided representation from all provincial health authorities and a range of urban contexts.
A total of 22 currently practising family doctors participated across the 6 focus groups, with groups ranging in size from 2 to 6 participants (average 4 participants).
Thematic analysis of the transcripts identified cross-cutting themes that emerged across the 6 focus groups.
Participants reported that medical tourism threatened patients' continuity of care. Informational continuity is disrupted before patients go abroad because patients regularly omit family doctors from preoperative planning and upon return home when patients lack complete or translated medical reports. Participants believed that their responsibilities to patients resumed once the patients had returned home from care abroad, but were worried about not being able to provide adequate follow-up care. Participants were also concerned about bearing legal liability toward patients should they be asked to clinically support treatments started abroad.
Medical tourism poses challenges to Canadian family doctors when trying to reconcile their traditional roles and responsibilities with the novel demands of private out-of-country care pursued by their patients. Guidance from professional bodies regarding physicians' responsibilities to Canadian medical tourists is currently lacking. Developing these supports would help address challenges faced in clinical practice.
Notes
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PubMed ID
24336547 View in PubMed
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Chronically ill Canadians' experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia.

https://arctichealth.org/en/permalink/ahliterature122600
Source
BMC Fam Pract. 2012;13:69
Publication Type
Article
Date
2012
Author
Valorie A Crooks
Gina Agarwal
Angela Harrison
Author Affiliation
Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. crooks@sfu.ca
Source
BMC Fam Pract. 2012;13:69
Date
2012
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
British Columbia
Canada
Chronic Disease - ethnology - psychology
Female
Focus Groups
Healthcare Disparities - ethnology - standards
Humans
Male
Middle Aged
Physician-Patient Relations
Poverty - ethnology - psychology
Questionnaires
Root Cause Analysis
Social Class
Social Desirability
Abstract
Unattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients' experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives.
Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada's health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.
Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.
Participants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.
Notes
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PubMed ID
22799280 View in PubMed
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A comparative analysis of potential spatio-temporal access to palliative care services in two Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature269238
Source
BMC Health Serv Res. 2015;15:270
Publication Type
Article
Date
2015
Author
Nadine Schuurman
Ofer Amram
Valorie A Crooks
Rory Johnston
Allison Williams
Source
BMC Health Serv Res. 2015;15:270
Date
2015
Language
English
Publication Type
Article
Keywords
Health facilities
Health Policy
Health Services Accessibility
Humans
Newfoundland and Labrador
Palliative Care
Rural Health Services
Saskatchewan
Spatio-Temporal Analysis
Abstract
Access to health services such as palliative care is determined not only by health policy but a number of legacies linked to geography and settlement patterns. We use GIS to calculate potential spatio-temporal access to palliative care services. In addition, we combine qualitative data with spatial analysis to develop a unique mixed-methods approach.
Inpatient health care facilities with dedicated palliative care beds were sampled in two Canadian provinces: Newfoundland and Saskatchewan. We then calculated one-hour travel time catchments to palliative health services and extended the spatial model to integrate available beds as well as documented wait times.
26 facilities with dedicated palliative care beds in Newfoundland and 69 in Saskatchewan were identified. Spatial analysis of one-hour travel times and palliative beds per 100,000 population in each province showed distinctly different geographical patterns. In Saskatchewan, 96.7% of the population living within a-1 h of drive to a designated palliative care bed. In Newfoundland, 93.2% of the population aged 65+ were living within a-1 h of drive to a designated palliative care bed. However, when the relationship between wait time and bed availability was examined for each facility within these two provinces, the relationship was found to be weak in Newfoundland (R(2)?=?0.26) and virtually nonexistent in Saskatchewan (R(2)?=?0.01).
Our spatial analysis shows that when wait times are incorporated as a way to understand potential spatio-temporal access to dedicated palliative care beds, as opposed to spatial access alone, the picture of access changes.
Notes
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PubMed ID
26183702 View in PubMed
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Critically examining diversity in end-of-life family caregiving: implications for equitable caregiver support and Canada's Compassionate Care Benefit.

https://arctichealth.org/en/permalink/ahliterature119283
Source
Int J Equity Health. 2012;11:65
Publication Type
Article
Date
2012
Author
Melissa Giesbrecht
Valorie A Crooks
Allison Williams
Olena Hankivsky
Author Affiliation
Department of Geography, Simon Fraser University, Burnaby, BC, Canada. mgiesbre@sfu.ca
Source
Int J Equity Health. 2012;11:65
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Caregivers - economics - organization & administration
Culture
Female
Financing, Government - economics - organization & administration
Health Care Surveys
Health Services Accessibility
Healthcare Disparities - economics - organization & administration - statistics & numerical data
Humans
Interviews as Topic
Male
Palliative Care - economics - organization & administration
Sex Factors
Socioeconomic Factors
Terminal Care - economics - organization & administration
Abstract
Family (i.e., unpaid) caregiving has long been thought of as a 'woman's issue', which ultimately results not only in gendered, but also financial and health inequities. Because of this, gender-based analyses have been prioritized in caregiving research. However, trends in current feminist scholarship demonstrate that gender intersects with other axes of difference, such as culture, socio-economic status, and geography to create diverse experiences. In this analysis we examine how formal front-line palliative care providers understand the role of such diversities in shaping Canadian family caregivers' experiences of end-of-life care. In doing so we consider the implications of these findings for a social benefit program aimed at supporting family caregivers, namely the Compassionate Care Benefit (CCB).
This analysis contributes to a utilization-focused evaluation of Canada's CCB, a social program that provides job security and limited income assistance to Canadian family caregivers who take a temporary leave from employment to provide care for a dying family member at end-of-life. Fifty semi-structured phone interviews with front-line palliative care providers from across Canada were conducted and thematic diversity analysis of the transcripts ensued.
Findings reveal that experiences of caregiving are not homogenous and access to services and supports are not universal across Canada. Five axes of difference were commonly raised by front-line palliative care providers when discussing important differences in family caregivers' experiences: culture, gender, geography, lifecourse stage, and material resources. Our findings reveal inequities with regard to accessing needed caregiver services and resources, including the CCB, based on these axes of difference.
We contend that without considering diversity, patterns in vulnerability and inequity are overlooked, and thus continually reinforced in health policy. Based on our findings, we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities and inequities while identifying implications for the CCB program as it is currently administered. From a policy perspective, this analysis demonstrates why diversity needs to be acknowledged in policy circles, including in relation to the CCB, and seeks to counteract single dimensional approaches for understanding caregiver needs at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance evaluative health policy research.
Notes
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PubMed ID
23116474 View in PubMed
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"Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

https://arctichealth.org/en/permalink/ahliterature257233
Source
BMC Med Ethics. 2013;14:37
Publication Type
Article
Date
2013
Author
Jeremy Snyder
Valorie A Crooks
Rory Johnston
Shafik Dharamsi
Author Affiliation
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. jcs12@sfu.ca.
Source
BMC Med Ethics. 2013;14:37
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Choice Behavior - ethics
Decision Making - ethics
Ethical Analysis
Female
Focus Groups
Humans
Informed Consent - ethics - standards
Male
Medical Tourism - ethics - legislation & jurisprudence - trends
Middle Aged
Physician's Role
Physician-Patient Relations - ethics
Physicians, Family - ethics - standards - trends
Social Responsibility
Abstract
Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism.
Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance.
Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy.
Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad.
Notes
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PubMed ID
24053385 View in PubMed
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