Purpose:This systematic review investigates how sociodemographic factors influence diabetic retinopathy (DR) screening adherence among individuals with diabetes. The review examines individuals with diabetes as the target population, focusing on the impact of various sociodemographic exposures on DR screening uptake.Methods:A comprehensive systematic search was conducted across Ovid MEDLINE, Embase, and the Cochrane Library from inception to November 2024. The primary outcome was the overall rate of DR screening among individuals, while secondary outcomes included the odds ratios or proportions of individuals screened for DR, stratified by sociodemographic factors.Results:Thirty-three studies were included, spanning more than 100,000 participants. Older age, higher education, higher income, and private insurance were consistently associated with higher screening adherence. Employed individuals, particularly those in manual labor or with rigid schedules, had lower participation. Women generally showed higher adherence, although findings varied. Ethnic disparities were observed, with Black and Hispanic populations demonstrating lower screening rates. Geographic distance and travel burden were frequently reported barriers.Conclusion:This review demonstrates that sociodemographic factors significantly affect DR screening adherence. Strengths include the broad geographic scope and diversity of populations studied. Limitations involve study heterogeneity and occasional reliance on self-reported data.
CONTEXT:Enhancing end-of-life care requires valid measurement of the quality of dying and death, but existing measures of this outcome have limited applicability across varied cultural and resource settings. To address this gap, we revised the Quality of Dying and Death Questionnaire (QODD) to create the QODD-Revised Global Version (QODD-RGV). OBJECTIVES:Our objective was to conduct a preliminary evaluation of the content validity of the QODD-RGV questionnaire in North American inpatient hospice settings based on item relevance, comprehensibility, and comprehensiveness. METHODS:Bereaved caregivers of patients who died in inpatient hospices in Canada and the United States were recruited 4-6 months after death of the patient. Participants completed the QODD-RGV, a 26-item measure assessing the experience of patients in the last week of life regarding symptoms, care preferences, and social support. Cognitive interviews were conducted with verbal probing and think-aloud techniques to evaluate the participants' understanding of the items and the information they relied upon to make their ratings. Interview transcripts were coded independently by two team members followed by consensus coding. Qualitative content analysis was performed. RESULTS:Eighteen cognitive interview protocols were completed. Participants indicated that their ratings were most commonly based on information from the perspective of the patient or themselves. The most common judgment strategy was comparison to "a hoped for or ideal dying experience," followed by "a state of distress/no distress." All respondents used multiple standards of comparison. Response difficulty was most frequently due to lack of communication with the patient. No single item was consistently misunderstood, but there was uncertainty about the ratings of some items due to limited caregiver knowledge or time spent communicating with the patient. CONCLUSION:The present study with bereaved caregivers in North American inpatient hospice settings provides preliminary evidence supporting the content validity of the QODD-RGV in North American hospice settings based on relevance, comprehensibility, and comprehensiveness of the items.
This article discusses the risks under New Zealand or Australian competition law of sharing price information with competitors. In particular, it discusses relevant case law as to when competitors sharing price information is indicative of an unlawful arrangement or understanding to fix or control prices. Some specific contexts are also discussed such as the exchange of pricing information through a trade association, the discussion of product offerings that might be argued to impact on price, meetings between competitors that discuss prices, the risks that pricing discussions between competitors involve even when no agreement or understanding is reached, and the risks involved in joint tendering. The article suggests that as a general rule competitors should avoid discussing with competitors the prices at which they sell products or services to their customers.
Outcomes 1. Participants will demonstrate understanding of the importance of culturally relevant end-of-life outcome measurement tools for assessment of end-of-life care.2. Participants will recognize that bereaved caregivers use multiple perspectives and judgment strategies in assessing the quality of their loved ones’ dying experience. Key Message The revised global version of the Quality of Dying and Death Questionnaire (QODD-RGV) was evaluated for content validity through cognitive interviews with bereaved caregivers. Findings confirmed that all items were understandable and relevant. All caregivers used various perspectives and faced some confusion about the time frame instructions, leading to revisions. Abstract Improvement in end-of-life care requires measurement of the quality of dying and death, but measures lack cross-cultural validity. We therefore revised the Quality of Dying and Death Questionnaire (QODD) (1, 2) to create the QODD-Revised Global Version (QODD-RGV) questionnaire (3). Objectives The aim of this study was to evaluate the content validity of the QODD-RGV. Methods Bereaved caregivers of patients who died in inpatient hospice residences in Canada and United States were recruited four-six months after death. As proxy raters, these caregivers completed the QODD-RGV, a 26-item measure assessing domains that include symptoms, preferences for care, and social support. They then participated in cognitive interviews verbalizing their thought process following each item response. Interview transcripts were independently coded by two research team members followed by consensus coding. Qualitative content analysis was used for data analysis, focusing on the sources participants relied on, their judgement strategies, and difficulties in responding to individual items. Results Eighteen bereaved caregivers participated in the cognitive interview protocol. The information retrieved was most commonly obtained from the perspective of the patient or the caregiver. The judgment strategies used most often were comparison to “a hoped for or ideal dying experience,” followed by “a state of distress/no distress.” All respondents used multiple standards of comparison. Response difficulty was most frequently due to “no communication with the patient regarding that aspect of the experience.” No single question was confusing to participants, but ambiguity regarding the instructions about the time frame to be evaluated led to its revision. Conclusions The QODD-RGV items were all understandable to participants and considered relevant by them, supporting the content validity of the QODD-RGV. Caregivers considered multiple perspectives and judgment strategies in their ratings, highlighting the complexity of the construct of the quality of dying and death and of proxy ratings. References 1. Curtis JR, Patrick DL, Engelberg RA, et al. A Measure of the Quality of Dying and Death. Journal of Pain and Symptom Management 2002;24(1):17–31; doi: 10.1016/S0885-3924(02)00419-0. 2. Hales S, Zimmermann C, Rodin G. Review: The quality of dying and death: a systematic review of measures. Palliat Med 2010;24(2):127–144; doi: 10.1177/0269216309351783. 3. An E, Tilly A, Mah K, et al. Protocol for the development and multisite validation of the Quality of Dying and Death-Revised Global Version scale. BMJ Open 2022;12(7):e064508; doi: 10.1136/bmjopen-2022-064508.
Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada The Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada Access to Care Program, Health System Performance and Support Portfolio, Ontario Health, Toronto, Ontario, Canada Kensington Eye Institute, Kensington Health, Toronto, Ontario, Canada Public Health Ontario, Toronto, Ontario, Canada
