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Toronto, Canada

Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute
Healthcare Papers | Year: 2014

The article co-authored by Maureen Taylor and Sandra Martin raises important issues that are resulting in new debate and attention in our thinking concerning physician-assisted death. It is likely that a change in policy is forthcoming, especially with the emerging force of a growing demographic who value personal choice and autonomy and are well-versed in the range of medical technologies and practices available. The issue of physician-assisted death cannot be understood apart from considering current models of healthcare and the role of adequate supportive care and psychosocial support. Despite having access to research and frameworks to inform quality palliative care, as well as communication competencies and guidelines to assist practitioners in the management of debilitating symptoms, our current healthcare system consists of healthcare professionals who continue to be challenged in their abilities to alleviate complex and challenging symptoms and distress. We will need to carefully assess our systems and plan well ahead for changes in policy to provide optimal, ethical and safe approaches to the offering of services around assisted death as an option for endof-life care.

Rashleigh L.,De Souza Institute
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2011

There is a growing body of evidence to support that specialization in nursing leads to improved outcomes for patients, including increased QOL, improved symptom management, and fewer hospital admissions. Oncology nurses face several challenges in pursuing specialization, due to individual and system issues such as limited time and resources. To address these challenges, de Souza Institute launched a province-wide study group for nurses in Ontario who planned to write the Canadian Nurses Association (CNA) Oncology Certification Exam. The study group was led by educators from de Souza and Princess Margaret Hospital and drew expertise from nursing leaders across Ontario who shared the same vision of oncology nursing excellence. The study group was innovative by embracing telemedicine and web-based technology, which enabled flexibility for nurses' work schedules, learning styles, physical location and practice experience. The study group utilized several theoretical perspectives and frameworks to guide the curriculum: Adult Learning Theories, Cooperative Learning, Generational Learning Styles, CANO standards for practice and the CNA exam competencies. This approach enabled 107 oncology nurses across the province in 17 different sites to connect, as a group, study interactively and fully engage in their learning. A detailed evaluation method was utilized to assess baseline knowledge, learning needs, cooperative group process, exam success rates, and document unexpected outcomes. Ninety-four per cent of participants passed the CNA Oncology Exam. Lessons learned and future implications are discussed. The commitment remains to enable thriving through generating new possibilities, building communities of practice, mentoring nurses and fostering excellence in oncology practice.

Gayner B.,Sinai University | Gayner B.,University of Toronto | Esplen M.J.,Toronto General Research Institute | De Roche P.,Sinai University | And 6 more authors.
Journal of Behavioral Medicine | Year: 2012

To determine whetherMBSR groups would help gay men living with HIV improve psychosocial functioning and increase mindfulness compared to treatment-as-usual (TAU). Methods: 117 participants were randomized 2:1 to MBSR or TAU. No new psychosocial or psychopharmacological interventions were initiated within 2 months of baseline. Standardized questionnaires were administered pre-, postintervention and at 6 months. An intent-to-treat analysis found significant benefits of MBSR: at post-intervention and 6 months follow up, MBSR participants had significantly lower avoidance in IES and higher positive affect compared to controls. MBSR participants developed more mindfulness as measured by the Toronto Mindfulness Scale (TMS) including both TMS subscales, curiosity and decentering, at 8-week and 6 months. For the sample as a whole, increase in mindfulness was significantly correlated with reduction in avoidance, higher positive affect and improvement in depression at 6 months. MBSR has specific and clinically meaningful effects in this population. © Springer Science+Business Media, LLC 2011.

Esplen M.J.,A+ Network | Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | Cappelli M.,Childrens Hospital of Eastern Ontario | And 13 more authors.
BMJ Open | Year: 2013

Objectives: To develop a brief, reliable and valid instrument to screen psychosocial risk among those who are undergoing genetic testing for Adult-Onset Hereditary Disease (AOHD). Design: A prospective two-phase cohort study. Setting: 5 genetic testing centres for AOHD, such as cancer, Huntington's disease or haemochromatosis, in ambulatory clinics of tertiary hospitals across Canada. Participants: 141 individuals undergoing genetic testing were approached and consented to the instrument development phase of the study (Phase I). The Genetic Psychosocial Risk Instrument (GPRI) developed in Phase I was tested in Phase II for item refinement and validation. A separate cohort of 722 individuals consented to the study, 712 completed the baseline package and 463 completed all follow-up assessments. Most participants were female, at the mid-life stage. Individuals in advanced stages of the illness or with cognitive impairment or a language barrier were excluded. Interventions: Phase I: GPRI items were generated from (1) a review of the literature, (2) input from genetic counsellors and (3) phase I participants. Phase II: further item refinement and validation were conducted with a second cohort of participants who completed the GPRI at baseline and were followed for psychological distress 1-month postgenetic testing results. Primary and secondary outcome measures: GPRI, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Brief Symptom Inventory (BSI) and Impact of Event Scale (IES). Results: The final 20-item GPRI had a high reliability-Cronbach's a at 0.81. The construct validity was supported by high correlations between GPRI and BSI and IES. The predictive value was demonstrated by a receiver operating characteristic curve of 0.78 plotting GPRI against follow-up assessments using HAM-D and HAM-A. Conclusions: With a cut-off score of 50, GPRI identified 84% of participants who displayed distress postgenetic testing results, supporting its potential usefulness in a clinical setting.

Esplen M.J.,A+ Network | Esplen M.J.,University of Toronto | Esplen M.J.,De Souza Institute | Wong J.,University of Toronto | And 10 more authors.
Clinical Genetics | Year: 2015

A cross-sectional study of 155 participants who underwent genetic testing for Lynch syndrome (LS) examined long-term psychosocial and behavioral outcomes. Participants completed standardized measures of perceived risk, psychosocial functioning, knowledge, and a questionnaire of screening activities. Participants were on average 47.3 years and had undergone testing a mean of 5.5 years prior. Eighty four (54%) tested positive for a LS mutation and 71 (46%) negative. For unaffected carriers, perceived lifetime risk of colorectal cancer was 68%, and surprisingly, 40% among those testing negative. Most individuals demonstrated normative levels of psychosocial functioning. However, 25% of those testing negative had moderate depressive symptoms, as measured by the Center for Epidemiologic Studies for Depression Scale, and 31% elevated state anxiety on the State-Trait Anxiety Inventory. Being female and a stronger escape - avoidant coping style were predictive of depressive symptoms. For state anxiety, similar patterns were observed. Quality of life and social support were significantly associated with lower anxiety. Carriers maintained higher knowledge compared to those testing negative, and were more engaged in screening. In summary, most individuals adapt to genetic test results over the long term and continue to engage in screening. A subgroup, including some non-carriers, may require added psychosocial support. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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