Background:Patient-centered care requires knowledge of patients’ goals of care (GoC) on the part of health care providers (HCPs). Whether HCPs caring for in-center hemodialysis patients meet this criterion is uncertain.Objective:We designed and conducted a GoC survey among patients and HCPs within a single in-center hemodialysis (ICHD) program to determine whether HCPs have an understanding of their patients’ GoC.Design:This was a prospective comparative quantitative survey study.Setting:The study included a single Canadian maintenance ICHD center.Participants:These included hemodialysis patients and their primary nephrologists, nurses, social workers, pharmacists, and dietitians.Methods and Measurements:Two surveys, one for patients and another for primary HCPs, were designed, piloted, and administered. For each participating patient, HCPs consisted of the primary nephrologist, nurse, social worker, pharmacist, and dietitian. Surveys included questions pertaining to 7 GoC themes. Patient-HCP agreement on the importance of each domain individually and the most important domain overall was assessed with kappa statistics. Factors influencing agreement were assessed with logistic regression in a secondary analysis.Results:A total of 173 patients were invited to participate, of whom 137 (79%) completed surveys. Fifty HCPs completed 623 corresponding surveys: 132 by physicians, 112 by nurses, 126 by pharmacists, 127 by social workers, and 126 by dietitians. A total of 70.1% and 78.8% of patients agreed with the importance of and would feel comfortable having GoC discussions, respectively, with their HCPs; 42.7% of physicians reported not having provided prognostic information to the corresponding patient. Patient-HCP agreement regarding GoC was poor (all κ < .25, all P values > .05). In adjusted analyses, only patients choosing “Be Cured” as the most important GoC was significantly associated with poorer HCP-patient agreement than expected (odds ratio, 0.04; 95% confidence interval, 0.01-0.18).Limitations:This is a single-center study involving only ICHD patients.Conclusions:HCP perceptions of GoC did not agree with patients’ reported GoC. This study suggests the need for the design and validation of interventions to improve HCPs’ understanding of their patients’ GoC.

This study investigated childhood physical abuse and ulcers in a regionally representative community sample. Age, race and sex were controlled for in addition to five clusters of potentially confounding factors: adverse childhood conditions, adult socioeconomic status, current health behaviors, current stress and marital status, and history of mood/anxiety disorders. Childhood physical abuse is associated with many negative physical and psychological adult health outcomes. Two recent studies demonstrate a potential link between childhood physical abuse and peptic ulcer disease in adulthood. The authors use regional data for the Canadian provinces of Manitoba and Saskatchewan from the 2005 Canadian Community Health Survey. Of the 13,069 respondents with complete data on abuse and ulcers, 7.3% (n = 1,020) report that they had been physically abused as a child by someone close to them and 3.0% (n = 493) report that they had been diagnosed with peptic ulcers by a health professional. The regional response rate is approximately 84%. Findings show that those reporting abuse had more than twice the prevalence of ulcers than did those not reporting abuse (6.6% vs. 2.7%). The fully adjusted odd ratio of peptic ulcers among those who had reported childhood physical abuse is 1.68 (95% CI = 1.22, 2.32). A significant and stable relationship between childhood physical abuse and peptic ulcers is found, even when taking into account five clusters of potentially confounding factors. Prospective studies that apply the biopsychosocial model are likely to be the most effective for identifying the pathways that connect childhood physical abuse and ulcer disease.

Recruiting participants for a research project can be challenging. Incentives, particularly monetary incentives, have been shown to increase response rates. Offering a monetary incentive for participation in a research study can become very costly for the investigators. For this reason some researchers, including graduate students involved in under-funded projects, have resorted to lottery compensation to attract participants. From an ethical standpoint, all participants in a research study should be treated equally and fairly. Compensation lotteries, however, undermine equal treatment of all participants (notion of justice) because they prevent equal distribution of rewards. In this pilot study, we were interested in exploring and understanding the prevalence and determinants of the use of lottery compensation method by graduate students from Canadian universities as a way of compensating participants in their research studies. A sample of 50 students from five major Canadian universities participated. Three methods of compensation were identified in this study: cash reimbursement, grade mark and lottery draw for a prize. Results show that the availability of funding is the main determinant of the use of lottery compensation: students with sufficient funds were more likely to use cash incentives, while those without adequate funds were more likely to use lottery draws. Ethical implications are further discussed.

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