51
|
Hogervorst S, Adriaanse M, Brandt H, Vervloet M, van Dijk L, Hugtenburg J. Feasibility study of a digitalized nurse practitioner-led intervention to improve medication adherence in type 2 diabetes patients in Dutch primary care. Pilot Feasibility Stud 2021; 7:152. [PMID: 34362471 PMCID: PMC8349070 DOI: 10.1186/s40814-021-00892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The purpose of this feasibility study was to improve and implement an intervention aimed at enhancing medication adherence in sub-optimally controlled and non-adherent type 2 diabetes (T2DM) patients in primary care. Methods Four phases were completed: (1) context analysis, (2) collaboration protocol development, (3) digitalization, and (4) process evaluation. Two community pharmacies and seven general practices participated. In phase 1, two focus groups were conducted, of which one with healthcare providers (HCP, N = 5) and one with patients (N = 11). In phase 4, four semi-structured interviews and one focus group (N = 6) were conducted with healthcare providers. The goal of these focus groups and interviews was to obtain insights into current care to support medication adherence (phase 1), opportunities for collaboration (phase 2) and process evaluation (phase 4). Data were analyzed in Atlas.ti using thematic analyses. Results Both T2DM patients and HCPs considered medication adherence vital. Suboptimal collaboration between HCPs and unreliable ways to monitor medication non-adherence appeared important barriers for adequate care to support medication adherence (phase 1). The nurse practitioner (NP) was chosen as the interventionist with supportive roles for other HCPs (phase 2). All components of the intervention were digitalized (phase 3). The implementation of the digitalized intervention was reported to be suboptimal (phase 4). Main reasons were that pharmacy refill data were unreliable, NPs experienced difficulties addressing medication non-adherence adequately and collaboration between HCPs was suboptimal. Conclusions The medication adherence enhancing intervention was successfully digitalized, but implementation of the digitalized intervention appeared not feasible as of yet. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00892-2.
Collapse
Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Marcel Adriaanse
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hella Brandt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marcia Vervloet
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Jacqueline Hugtenburg
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
52
|
Jones J, Cowe M, Marks S, McAllister T, Mendoza A, Ponniah C, Wythe H, Mathie E. Reporting on patient and public involvement (PPI) in research publications: using the GRIPP2 checklists with lay co-researchers. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:52. [PMID: 34294148 PMCID: PMC8296743 DOI: 10.1186/s40900-021-00295-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/01/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Patient and public involvement (PPI) in health and social care research is considered important internationally, with increasing evidence that PPI improves the quality, relevance and outcomes of research. There has been a growth in research publications that describe PPI in the research process, but the frequency and detail of PPI reporting varies considerably. This paper reports on a collaborative study that aimed to describe the extent of PPI in publications from research funded by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) in the East of England (EoE), part of the National Institute of Health Research (NIHR) in England (2014-2019). METHODS A descriptive study of all research publications (1st January 2014 to 31st October 2017) funded by the NIHR CLAHRC EoE. Members of the Public Involvement in Research group (PIRg), at the University of Hertfordshire, were actively involved, with four PIRg co-researchers. We used an internationally recognised reporting checklist for PPI called the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public, Version 2) to guide the reviewing process. RESULTS Out of 148 research papers identified, 16 (14%) reported some aspect of PPI activity and were included for review. Ten of the publications (63%) acknowledged the contributions of PPI individuals and/or groups and five had PPI co-authors. There was considerable variation in the PPI reported in the publications, with some 'missed opportunities' to provide detail of PPI undertaken. The perspectives of the co-researchers shaped the reporting of the results from this study. The co-researchers found the GRIPP2-SF (short form) to be useful, but the GRIPP2-LF (long form) was considered over complicated and not user-friendly. CONCLUSIONS This is one of the first studies to involve lay co-researchers in the review of PPI reporting using the GRIPP2 reporting checklists (GRIPP2-SF and GRIPP2-LF). We make recommendations for a revised version of the GRIPP2-SF, with clearer instructions and three additional sections to record whether PPI is reported in the abstract or key words, in the acknowledgements section, and whether there are PPI co-authors. We also recommend the provision of training and support for patient and public peer reviewers.
Collapse
Affiliation(s)
- Julia Jones
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, AL10 9AB England
| | - Marion Cowe
- Public Involvement in Research group (PIRg) member, CRIPACC, University of Hertfordshire, Hatfield, AL10 9AB England
| | - Sue Marks
- Public Involvement in Research group (PIRg) member, CRIPACC, University of Hertfordshire, Hatfield, AL10 9AB England
| | - Tony McAllister
- Public Involvement in Research group (PIRg) member, CRIPACC, University of Hertfordshire, Hatfield, AL10 9AB England
| | - Alex Mendoza
- Public Involvement in Research group (PIRg) member, CRIPACC, University of Hertfordshire, Hatfield, AL10 9AB England
| | - Carole Ponniah
- NIHR ARC East of England, School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ England
| | - Helena Wythe
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, AL10 9AB England
| | - Elspeth Mathie
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, AL10 9AB England
| |
Collapse
|
53
|
Optimising Multi-stakeholder Practices in Patient Engagement: A Gap Analysis to Enable Focused Evolution of Patient Engagement in the Development and Lifecycle Management of Medicines. Ther Innov Regul Sci 2021; 55:1165-1179. [PMID: 34181236 PMCID: PMC8492561 DOI: 10.1007/s43441-021-00313-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Background The PARADIGM consortium aimed to make patient engagement in the development and lifecycle management of medicines easier and more effective for all, with the development of new tools that fulfil robustly defined gaps where engagement is suboptimal. Aims To generate an inventory of gaps in patient engagement practices and process from existing global examples. Methods A large set of criteria for effective patient engagement previously defined via a multi-stakeholder Delphi method, were mapped under fourteen overarching themes. A gap analysis was then performed by twenty-seven reviewers against the resulting forty-six mapped criteria, on a sample of seventy initiatives from global databases. Results An inventory of gaps was identified including contextual information as to why the gaps exist. Our work identified general patterns where patient engagement was suboptimal—defined as; fragmented reporting and dissemination of patient engagement activities, and the fundamental principles defined in frameworks or guidance being poorly adhered to in actual practice. Specific gaps were identified for sixteen criteria. Additionally, it was also common to observe primary aspects of a process were addressed for a given criteria (i.e. training for roles and responsibilities) but a secondary context element was lacking (i.e. making training material accessible/understandable/meaningful to all participants). Conclusion The results show that the evolution towards meaningful and systematic patient engagement is occurring, yet more importantly they provide clear directional insights to help enhance collaborative practices and co-design solutions. This targeted impact to catalyse a needs-oriented health system that integrates patient engagement at its core is essential. Supplementary Information The online version contains supplementary material available at 10.1007/s43441-021-00313-9.
Collapse
|
54
|
Ellis U, Kitchin V, Vis-Dunbar M. Identification and Reporting of Patient and Public Partner Authorship on Knowledge Syntheses: Rapid Review. J Particip Med 2021; 13:e27141. [PMID: 34110293 PMCID: PMC8235296 DOI: 10.2196/27141] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) in health research is an area of growing interest. Several studies have examined the use and impact of PPI in knowledge syntheses (systematic, scoping, and related reviews); however, few studies have focused specifically on the patient or public coauthorship of such reviews. OBJECTIVE This study seeks to identify published systematic and scoping reviews coauthored by patient or public partners and examine the characteristics of these coauthored reviews, such as which journals publish them, geographic location of research teams, and terms used to describe patient or public partner authors in affiliations, abstracts, or article text. METHODS We searched CAB Direct, CINAHL, Cochrane Database of Systematic Reviews (Ovid), Embase (Ovid), MEDLINE (Ovid), and PsycInfo from 2011 to May 2019, with a supplementary search of several PPI-focused databases. We refined the Ovid MEDLINE search by examining frequently used words and phrases in relevant search results and searched Ovid MEDLINE using the modified search strategy in June 2020. RESULTS We screened 13,998 results and found 37 studies that met our inclusion criteria. In line with other PPI research, we found that a wide range of terms were used for patient and public authors in author affiliations. In some cases, partners were easy to identify with titles such as patient, caregiver or consumer representative, patient partner, expert by experience, citizen researcher, or public contributor. In 11% (n=4) of studies, they were identified as members of a panel or advisory council. In 27% (n=10) of articles, it was either impossible or difficult to tell whether an author was a partner solely from the affiliation, and confirmation was found elsewhere in the article. We also investigated where in the reviews the partner coauthors' roles were described, and when possible, what their specific roles were. Often, there was little or no information about which review tasks the partner coauthors contributed to. Furthermore, only 14% (5/37) of reviews mentioned patient or public involvement as authors in the abstract; involvement was often only indicated in the author affiliation field or in the review text (most often in the methods or contributions section). CONCLUSIONS Our findings add to the evidence that searching for coproduced research is difficult because of the diversity of terms used to describe patient and public partners, and the lack of consistent, detailed reporting about PPI. For better discoverability, we recommend ensuring that patient and public authorships are indicated in commonly searched database fields. When patient and public-authored research is easier to find, its impact will be easier to measure.
Collapse
Affiliation(s)
- Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Kitchin
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Mathew Vis-Dunbar
- University of British Columbia Okanagan Library, Kelowna, BC, Canada
| |
Collapse
|
55
|
Vanderloo LM, Vanderhout SM, Tavares E, Maguire J, Straus S, Birken CS. Parent engagement in co-design of clinical trials: the PARENT trial. Trials 2021; 22:347. [PMID: 34001229 PMCID: PMC8130403 DOI: 10.1186/s13063-021-05305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents' experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.
Collapse
Affiliation(s)
- Leigh M Vanderloo
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
- School of Occupational Therapy, Health & Rehabilitation Sciences, Western University, London, Canada.
| | - Shelley M Vanderhout
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Erika Tavares
- Genetics and Genome Biology, The Hospital for Sick Children Research Institute [Parent representative], Toronto, Canada
| | - Jonathon Maguire
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
56
|
Devan H, Perry MA, Yaghoubi M, Hale L. "A coalition of the willing": experiences of co-designing an online pain management programme (iSelf-help) for people with persistent pain. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:28. [PMID: 33975653 PMCID: PMC8112221 DOI: 10.1186/s40900-021-00275-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Participatory approaches to developing health interventions with end-users are recommended to improve uptake and use. We aimed to explore the experiences of co-designing an online-delivered pain management programme (iSelf-help) for people with persistent pain. METHODS A modified participatory action research (PAR) framework was used to co-design contents and delivery of iSelf-help. The PAR team included: (1) a patient advisory group consisting of people living with persistent pain (n = 8), (2) pain management service clinicians (n = 2), (3) health researchers (n = 3), (4) digital health experts (n = 2), (5) a health literacy expert, and (6) two Māori health researchers and our community partner who led the cultural appropriateness of iSelf-help for Māori (the Indigenous population of New Zealand). The iSelf-help co-design processes and activities of the 'PAR' team is reported in another paper. In this paper, all PAR team members were invited to share their experiences of the co-design process. Individual interviews were held with 12 PAR team members. Interview transcripts were analysed using the General Inductive Approach. RESULTS Five common themes were identified from the interviews: (1) Shared understanding and values of the co-design process, (2) Mismatched expectations with content creation, (3) Flexibility to share power and decision making, (4) Common thread of knowledge, and (5) Shared determination. Sustaining these themes was an overarching theme of "A coalition of the willing". CONCLUSIONS PAR team members valued the shared determination and responsibility to co-design iSelf-help. They also acknowledged the complexities and challenges during the process related to mismatched expectations, power sharing and establishing a common thread of knowledge. Successful co-design requires a shared commitment and responsibility as a coalition to meet the aspirations of end-users, within the boundaries of time and budget.
Collapse
Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Mostafa Yaghoubi
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin, New Zealand
| |
Collapse
|
57
|
Michaud S, Needham J, Sundquist S, Johnson D, Hanna S, Hosseinzadeh S, Bartekian V, Steele P, Benchimol S, Ross N, Stein BD. Patient and Patient Group Engagement in Cancer Clinical Trials: A Stakeholder Charter. ACTA ACUST UNITED AC 2021; 28:1447-1458. [PMID: 33917947 PMCID: PMC8167642 DOI: 10.3390/curroncol28020137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
Background-to guide the implementation of patient centricity and engagement in cancer clinical trials (CTs) and to operationalize the Canadianized version of the Clinical Trials Transformation Initiative (C-CTTI) model, the development of a charter was identified by cancer CT stakeholders. Methods-the Canadian Cancer Trial Stakeholder Charter (the Charter) was initiated by Colorectal Cancer Canada (CCC) and developed via the-1-formation of an inclusive working group (WG) that drafted the document using recommendations collected during the development of the C-CTTI model; 2-socialization of the draft Charter to solicit feedback from cancer CT stakeholders, including those who attended the 2019 CCC Conference; and 3-incorporation of stakeholders' feedback and finalization of the Charter by the WG. Results-the Charter was built around five guiding principles-1-patient centricity; 2-commitment to education and training; 3-collaboration as equal and independent partners in research; 4-transparency and accountability; and 5-high standards in data collection integrity and honesty. These principles led to the Charter's five tenets, which stipulate stakeholder commitments, aiming to make CTs accessible to all patients, improve the design and implementation of CTs to benefit patients, expand recruitment and retention of patients in CTs, and further advance cancer research and treatment. Conclusions-the Charter is intended to integrate the patient voice into the Canadian cancer CT continuum. The next phases of the C-CTTI model include the adoption and implementation of the Charter, the establishment of a patient group training program, and the development of real-world evidence/real-world data methodologies.
Collapse
Affiliation(s)
| | - Judy Needham
- Canadian Cancer Trials Group, Kingston, ON K7L 3N6, Canada;
| | - Stephen Sundquist
- Canadian Cancer Clinical Trials Network (3CTN), Toronto, ON M5G 0A3, Canada;
| | - Dominique Johnson
- McPeak-Sirois Group for Clinical Research in Breast Cancer, Montreal, QC H2Y 2H2, Canada;
| | - Sabrina Hanna
- The Cancer Collaborative, Montreal, QC H7W 0C3, Canada;
| | | | | | - Patricia Steele
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | - Sarita Benchimol
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | | | - Barry D. Stein
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
- Correspondence:
| |
Collapse
|
58
|
Vat LE, Finlay T, Robinson P, Barbareschi G, Boudes M, Diaz Ponce AM, Dinboeck M, Eichmann L, Ferrer E, Fruytier SE, Hey C, Broerse JEW, Schuitmaker‐Warnaar TJ. Evaluation of patient engagement in medicine development: A multi-stakeholder framework with metrics. Health Expect 2021; 24:491-506. [PMID: 33629470 PMCID: PMC8077089 DOI: 10.1111/hex.13191] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patient engagement is becoming more customary in medicine development. However, embedding it in organizational decision-making remains challenging, partly due to lack of agreement on its value and the means to evaluate it. The objective of this project was to develop a monitoring and evaluation framework, with metrics, to demonstrate impact and enhance learning. METHODS A consortium of five patient groups, 15 biopharmaceutical companies and two academic groups iteratively created a framework in a multi-phase participatory process, including analysis of its application in 24 cases. RESULTS The framework includes six components, with 87 metrics and 15 context factors distributed among (sub)components: (a) Input: expectations, preparations, resources, representativeness of stakeholders; (b) Activities/process: structure, management, interactions, satisfaction; (c) Learnings and changes; (d) Impacts: research relevance, study ethics and inclusiveness, study quality and efficiency, quality of evidence and uptake of products, empowerment, reputation and trust, embedding of patient engagement; (e) Context: policy, institutional, community, decision-making contextual factors. Case study findings show a wide variation in use of metrics. There is no 'one size fits all' set of metrics appropriate for every initiative or organization. Presented sample sets of metrics can be tailored to individual situations. CONCLUSION Introducing change into any process is best done when the value of that change is clear. This framework allows participants to select what metrics they value and assess to what extent patient engagement has contributed. PATIENT CONTRIBUTION Five patient groups were involved in all phases of the study (design, conduct, interpretation of data) and in writing the manuscript.
Collapse
Affiliation(s)
- Lidewij Eva Vat
- Athena InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Teresa Finlay
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | | | - Mathieu Boudes
- European Patients' Forum (EPF)Chaussée d’EtterbeekBrusselsBelgium
| | | | | | | | | | - Sevgi E. Fruytier
- Athena InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | | |
Collapse
|
59
|
Han HR, Xu A, Mendez KJW, Okoye S, Cudjoe J, Bahouth M, Reese M, Bone L, Dennison-Himmelfarb C. Exploring community engaged research experiences and preferences: a multi-level qualitative investigation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:19. [PMID: 33785074 PMCID: PMC8008581 DOI: 10.1186/s40900-021-00261-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Community engagement may make research more relevant, translatable, and sustainable, hence improving the possibility of reducing health disparities. The purpose of this study was to explore strategies for community engagement adopted by research teams and identify areas for enhancing engagement in future community engaged research. METHODS The Community Engagement Program of the Johns Hopkins Institute for Clinical and Translational Research hosted a forum to engage researchers and community partners in group discussion to reflect on their diverse past and current experiences in planning, implementing, and evaluating community engagement in health research. A total of 50 researchers, research staff, and community partners participated in five concurrent semi-structured group interviews and a whole group wrap-up session. Group interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. RESULTS Four themes with eight subthemes were identified. Main themes included: Community engagement is an ongoing and iterative process; Community partner roles must be well-defined and clearly communicated; Mutual trust and transparency are central to community engagement; and Measuring community outcomes is an evolving area. Relevant subthemes were: engaging community partners in various stages of research; mission-driven vs. "checking the box"; breadth and depth of engagement; roles of community partner; recruitment and selection of community partners; building trust; clear communication for transparency; and conflict in community engaged research. CONCLUSION The findings highlight the benefits and challenges of community engaged research. Enhanced capacity building for community engagement, including training and communication tools for both community and researcher partners, are needed.
Collapse
Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA.
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA.
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ashley Xu
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kyra J W Mendez
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Safiyyah Okoye
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mona Bahouth
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melanie Reese
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
- Older Women Embracing Life, Baltimore, MD, USA
| | - Lee Bone
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cheryl Dennison-Himmelfarb
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
| |
Collapse
|
60
|
Mendelson AA, Lansdell C, Fox-Robichaud AE, Liaw P, Arora J, Cailhier JF, Cepinskas G, Charbonney E, Dos Santos C, Dwivedi D, Ellis CG, Fergusson D, Fiest K, Gill SE, Hendrick K, Hunniford VT, Kowalewska PM, Krewulak K, Lehmann C, Macala K, Marshall JC, Mawdsley L, McDonald B, McDonald E, Medeiros SK, Muniz VS, Osuchowski M, Presseau J, Sharma N, Sohrabipour S, Sunohara-Neilson J, Vázquez-Grande G, Veldhuizen RAW, Welsh D, Winston BW, Zarychanski R, Zhang H, Zhou J, Lalu MM. National Preclinical Sepsis Platform: developing a framework for accelerating innovation in Canadian sepsis research. Intensive Care Med Exp 2021; 9:14. [PMID: 33738642 PMCID: PMC7973346 DOI: 10.1186/s40635-020-00366-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022] Open
Abstract
Despite decades of preclinical research, no experimentally derived therapies for sepsis have been successfully adopted into routine clinical practice. Factors that contribute to this crisis of translation include poor representation by preclinical models of the complex human condition of sepsis, bias in preclinical studies, as well as limitations of single-laboratory methodology. To overcome some of these shortcomings, multicentre preclinical studies—defined as a research experiment conducted in two or more research laboratories with a common protocol and analysis—are expected to maximize transparency, improve reproducibility, and enhance generalizability. The ultimate objective is to increase the efficiency and efficacy of bench-to-bedside translation for preclinical sepsis research and improve outcomes for patients with life-threatening infection. To this end, we organized the first meeting of the National Preclinical Sepsis Platform (NPSP). This multicentre preclinical research collaboration of Canadian sepsis researchers and stakeholders was established to study the pathophysiology of sepsis and accelerate movement of promising therapeutics into early phase clinical trials. Integrated knowledge translation and shared decision-making were emphasized to ensure the goals of the platform align with clinical researchers and patient partners. 29 participants from 10 independent labs attended and discussed four main topics: (1) objectives of the platform; (2) animal models of sepsis; (3) multicentre methodology and (4) outcomes for evaluation. A PIRO model (predisposition, insult, response, organ dysfunction) for experimental design was proposed to strengthen linkages with interdisciplinary researchers and key stakeholders. This platform represents an important resource for maximizing translational impact of preclinical sepsis research.
Collapse
Affiliation(s)
- Asher A Mendelson
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
| | - Casey Lansdell
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Patricia Liaw
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Jaskirat Arora
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Jean-François Cailhier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Gediminas Cepinskas
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
| | - Emmanuel Charbonney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Claudia Dos Santos
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dhruva Dwivedi
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Christopher G Ellis
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean E Gill
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Kathryn Hendrick
- Department of Communications, Global Sepsis Alliance, Canada Sector, Toronto, ON, Canada
| | - Victoria T Hunniford
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Karla Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kimberly Macala
- Department of Critical Care Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - John C Marshall
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Mawdsley
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ellen McDonald
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Sarah K Medeiros
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Valdirene S Muniz
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Neha Sharma
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Sahar Sohrabipour
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Gloria Vázquez-Grande
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Ruud A W Veldhuizen
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Donald Welsh
- Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Brent W Winston
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Section of Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Haibo Zhang
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Juan Zhou
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.
| | | |
Collapse
|
61
|
Smith K, Dowd-Green C, Emerson A, Bertram A, Stewart R. Does an encounter with the ambulatory clinical pharmacist in the transitional setting play a role in clinic attendance and patient engagement? J Am Pharm Assoc (2003) 2020; 61:e171-e175. [PMID: 33359116 DOI: 10.1016/j.japh.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/15/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient engagement is an important aspect in improving patient outcomes. However, there is a paucity of literature regarding patient engagement in a nonresearch health care setting and the impacts of ambulatory clinical pharmacist interventions. Patient engagement has several definitions making it challenging to assess, but attendance to initial primary care provider (PCP) visits is an important aspect of patient engagement. OBJECTIVE The study objective was to assess if improved patient engagement, defined as attendance to an initial PCP visit, was associated with differences in services provided or pharmacist participation during postdischarge clinic appointments. PRACTICE DESCRIPTION The site of this study was the Johns Hopkins After Care Clinic (JHACC), an interdisciplinary postdischarge, safety net clinic in Baltimore, MD. PRACTICE INNOVATION Through an interdisciplinary health care team including pharmacists, patients received comprehensive care to assist with postacute disease-state management and transitions of care. EVALUATION METHODS Initial PCP visit attendance after a postacute visit in a high-risk population was evaluated for differing service delivery factors between groups who attended and did not attend their initial PCP visit. Descriptive statistics and chi-square tests were used for analysis. RESULTS Patients were statistically significantly more likely to engage in primary care when clinical pharmacy specialists participated in their JHACC appointment (P = 0.02). Medication education and disease-state counseling improved initial PCP visit attendance, both of which are key pharmacist activities. CONCLUSION This study suggests ambulatory clinical pharmacy specialists' roles in an interdisciplinary clinic model correlates with increased attendance to initial PCP visits, a surrogate for patient engagement. Disease-state education and medication education are both important activities in improving this measure; however, additional research is necessary to determine specific pharmacist interventions associated with patient engagement. As research in patient engagement continues, the positive effects of pharmacist involvement in this area could support their value in ambulatory care services.
Collapse
|
62
|
Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure? Sleep Med Clin 2020; 16:125-144. [PMID: 33485525 DOI: 10.1016/j.jsmc.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibility.
Collapse
|
63
|
Kondylakis H, Axenie C, Kiran Bastola D, Katehakis DG, Kouroubali A, Kurz D, Larburu N, Macía I, Maguire R, Maramis C, Marias K, Morrow P, Muro N, Núñez-Benjumea FJ, Rampun A, Rivera-Romero O, Scotney B, Signorelli G, Wang H, Tsiknakis M, Zwiggelaar R. Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study. J Med Internet Res 2020; 22:e22034. [PMID: 33320099 PMCID: PMC7772066 DOI: 10.2196/22034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)-funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. OBJECTIVE This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020-funded projects. METHODS Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. RESULTS Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. CONCLUSIONS Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.
Collapse
Affiliation(s)
| | - Cristian Axenie
- Audi Konfuzius-Institut Ingolstadt Lab, Technische Hochschule Ingolstadt, Ingolstadt, Germany
| | - Dhundy Kiran Bastola
- School of Interdisciplinary Informatics, University of Nebraska, Omaha, NE, United States
| | | | | | - Daria Kurz
- Interdisziplinäres Brustzentrum, Helios Klinikum München West, Munich, Germany
| | - Nekane Larburu
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | - Iván Macía
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | - Roma Maguire
- University of Strathclyde, Glasgow, United Kingdom
| | - Christos Maramis
- eHealth Lab, Institute of Applied Biosciences - Centre for Research & Technology Hellas, Thessaloniki, Greece
| | | | - Philip Morrow
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | - Naiara Muro
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | | | - Andrik Rampun
- Academic Unit of Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - Bryan Scotney
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | | | - Hui Wang
- School of Computing and Engineering, University of West London, London, United Kingdom
| | | | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth, United Kingdom
| |
Collapse
|
64
|
Brehaut JC, Carroll K, Presseau J, Richards DP, Gordon J, Bénard A, Hudek N, Graham ID, Fergusson DA, Marlin S. A patient-focused, theory-guided approach to survey design identified barriers to and drivers of clinical trial participation. J Clin Epidemiol 2020; 132:106-115. [PMID: 33338563 DOI: 10.1016/j.jclinepi.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/16/2020] [Accepted: 12/08/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Despite clear evidence showing that many clinical trials fail or are delayed because of poor patient recruitment, there is surprisingly little empirically supported guidance for trialists seeking to optimize their trial recruitment strategies. We propose that the challenges of recruitment can be better understood and addressed by thinking of research participation as one or more behaviors, subject to the same forces as other human behaviors. In this article, we describe an adaptable, behavioral theory-driven approach for designing pretrial surveys of the barriers and drivers relevant to trial participation. Instead of proposing a single survey instrument intended to be used uniformly across many situations, we propose that tailored surveys be informed by a common comprehensive, theory-guided development approach that ensures all domains potentially guiding participation are considered. STUDY DESIGN AND SETTING We used the Theoretical Domains Framework (TDF), which organizes over 100 constructs known to be associated with behavior and behavior change into 14 domains that describe determinants of professional and patient health behaviors, to inform the development of tailored surveys about barriers to and drivers of clinical trial participation. After searching the literature for barriers and drivers to trial recruitment relevant to each of the TDF domains, we developed separate surveys for members of two national health charities (Canadian Breast Cancer Network, Huntington Society of Canada) to exemplify how the approach can be adapted across settings. We conducted think-aloud interviews with members of each group to maximize the clarity and usability of the surveys, elicited opinions about which barriers/drivers were relevant for each patient group, and identified additional barriers/drivers. Interviews proceeded iteratively with changes incorporated into subsequent interviews. Here, we describe our two target patient groups, as well as our process of modifying, adding, and deleting barrier/driver items for each group and across theoretical domains. RESULTS We interviewed 8 women with a history of breast cancer from the Canadian Breast Cancer Network (48-65 year old) and 11 Huntington Disease community members (9 women) from the Huntington Society of Canada (26-70 year old). After the iterative development interviews, the breast cancer group had identified 38 barriers/drivers thought relevant to their participation in clinical trials across 12 TDF domains. The Huntington group identified 47 items across 13 TDF domains. CONCLUSION Our patient-focused and theory-guided approach was able to identify a more comprehensive range of barriers to and drivers of trial participation than existing published tools. Our approach is also more broadly adaptable than such tools, in that it uses a theoretical framework and in-depth piloting to generate a set of items tailored to each specific clinical area, rather than a single set of items intended to be applicable to all situations. This theory-guided approach also enables more specific recruitment strategies to be developed once domain-specific barriers are known, potentially optimizing participation for a given trial and helping build a cumulative evidence of barriers/drivers and strategies for addressing them.
Collapse
Affiliation(s)
- Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada, K1G 5Z3.
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada, K1G 5Z3
| | - Dawn P Richards
- Clinical Trials Ontario, 661 University Avenue, Suite 460, MaRS Centre, West Tower, Toronto, Canada M5G 1M1
| | - Jenn Gordon
- Canadian Breast Cancer Network, 331 Cooper St. Suite 602, Ottawa, Canada, K2P 0G5
| | - Angèle Bénard
- Huntington Society of Canada (HSC), 20 Erb Street West, Suite 801, Waterloo, Ontario, N2L1T2
| | - Natasha Hudek
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada, K1G 5Z3
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa Ontario, Canada, K1H 8L6; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada, K1G 5Z3
| | - Susan Marlin
- Clinical Trials Ontario, 661 University Avenue, Suite 460, MaRS Centre, West Tower, Toronto, Canada M5G 1M1
| |
Collapse
|
65
|
Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults. Br J Anaesth 2020; 126:395-403. [PMID: 33279102 DOI: 10.1016/j.bja.2020.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Abstract
Engaging patients-defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them-as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.
Collapse
|
66
|
Bruce C, Harrison P, Giammattei C, Desai SN, Sol JR, Jones S, Schwartz R. Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes. JMIR Mhealth Uhealth 2020; 8:e17577. [PMID: 33174846 PMCID: PMC7688390 DOI: 10.2196/17577] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/11/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
Abstract
Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.
Collapse
Affiliation(s)
- Courtenay Bruce
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | | | - Shetal-Nicholas Desai
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Joshua R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States.,Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
| |
Collapse
|
67
|
Heckert A, Forsythe LP, Carman KL, Frank L, Hemphill R, Elstad EA, Esmail L, Lesch JK. Researchers, patients, and other stakeholders' perspectives on challenges to and strategies for engagement. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:60. [PMID: 33042576 PMCID: PMC7539495 DOI: 10.1186/s40900-020-00227-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is growing interest in patient and stakeholder engagement in research, yet limited evidence about effective methods. Since 2012, the Patient-Centered Outcomes Research Institute (PCORI) has funded patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders as research partners in study planning, conduct, and dissemination. This requirement, unique among large healthcare research funders in the US, provides an opportunity to learn about challenges encountered and specific strategies used by PCORI-funded study teams. The primary objective of this study is to describe -- from the perspective of PCORI investigators and research partners-the most common engagement challenges encountered in the first two years of the projects and promising strategies to prevent and overcome these challenges. METHODS Descriptive information about investigators, partners, and their engagement was collected from investigators via annual (N = 235) and mid-year (N = 40) project progress reporting to PCORI, and from their partners (N = 260) via voluntary survey. Qualitative data were analyzed using content and thematic analyses. RESULTS Investigators and partners most often described engagement challenges in three domains: (1) infrastructure to support engagement, (2) building relationships, and (3) maintaining relationships. Infrastructure challenges related to financial and human resources, including funding support and dedicated staff, identifying diverse groups of partners, and partners' logistical needs. Challenges for both building and maintaining relationships encompass a variety of aspects of authentic, positive interactions that facilitate mutual understanding, full participation, and genuine influence on the projects. Strategies to prevent or mitigate engagement challenges also corresponded overall to the same three domains. Both groups typically described strategies more generally, with applicability to a range of challenges rather than specific actions to address only particular challenges. CONCLUSION Meaningful engagement of patients and other stakeholders comes with challenges, as does any innovation in the research process. The challenges and promising practices identified by these investigators and partners, related to engagement infrastructure and the building and maintenance of relationships, reveal actionable areas to improve engagement, including organizational policies and resources, training, new engagement models, and supporting engagement by viewing it as an investment in research uptake and impact.
Collapse
Affiliation(s)
- Andrea Heckert
- Present Address, Independent Consultant, Portland, OR USA
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | - Laura P. Forsythe
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | - Kristin L. Carman
- Public and Patient Engagement, Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
| | | | - Rachel Hemphill
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | | | - Laura Esmail
- Present Address, Independent Consultant, Paris, France
- Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC, USA
| | - Julie Kennedy Lesch
- Public and Patient Engagement, Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
| |
Collapse
|
68
|
van Schelven F, van der Meulen E, Kroeze N, Ketelaar M, Boeije H. Patient and public involvement of young people with a chronic condition: lessons learned and practical tips from a large participatory program. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:59. [PMID: 33005440 PMCID: PMC7525958 DOI: 10.1186/s40900-020-00234-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/21/2020] [Indexed: 05/28/2023]
Abstract
PLAIN ENGLISH SUMMARY BackgroundYoung people with a chronic condition are increasingly involved in doing research and developing tools and interventions that concern them. Working together with patients is called Patient and Public Involvement (PPI). We know from the literature that PPI with young people with a chronic condition can be challenging. Therefore, it is important that everyone shares their lessons learned from doing PPI.AimWe want to share our lessons learned from a large program, called Care and Future Prospects. This program helps young people with a chronic condition to, for example, go to school or to find a job. It funded numerous projects that could contribute to this. In all projects, project teams collaborated with young people with a chronic condition.What did we doWe asked young people with a chronic condition and project teams about their experiences with PPI. Project teams wrote reports, were interviewed, and filled out a tool called the Involvement Matrix. Young people filled out a questionnaire.FindingsIn the article, we present our lessons learned. Examples are: it is important to involve young people with a chronic condition from the start of a project and everyone involved in a project should continuously discuss their responsibilities. We provide practical tips on how young people with a chronic condition and project teams can do this. A tip for young people is, for example: 'discuss with the project team what you can and want to do and what you need'. An example of a tip for project teams is: 'Take time to listen attentively to the ideas of young people'. ABSTRACT BackgroundThe Patient and Public Involvement (PPI) of young people with a chronic condition receives increasing attention in policy and practice. This is, however, not without its challenges. Consequently, calls have been made to share lessons learned during PPI practice.MethodsWe share our lessons learned from a large participatory program, called Care and Future Prospects. This program aims to improve the social position of young people aged 0-25 with a physical or mental chronic condition by funding participatory projects. We have drawn our lessons from 33 of these projects, using four data sources. One data source provided information from the perspective of young people with a chronic condition, i.e. questionnaires. Three data sources contained information from the perspectives of project teams, i.e. project reports, case studies of projects and Involvement Matrices. For most of the projects, we have information from multiple data sources.ResultsWe have combined the findings derived from all four data sources. This resulted in multiple lessons learned about PPI with young people with a chronic condition. Those lessons are divided into six themes, including practicalities to take into account at the start, involvement from the start, roles and responsibilities, support, flexibility and an open mind, and evaluation of process and outcomes.ConclusionsThe lessons learned have taught us that meaningful PPI requires effort, time and resources from both young people and project teams, from the beginning to the end. It is important to continuously discuss roles and responsibilities, and whether these still meet everyone's needs and wishes. Our study adds to previous research by providing practical examples of encountered challenges and how to deal with them. Moreover, the practical tips can be a valuable aid by showing young people and project teams what concrete actions can support a successful PPI process.
Collapse
Affiliation(s)
- Femke van Schelven
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | | | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Hennie Boeije
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
69
|
Cheung DST, Yeung WF, Chau PH, Lam TC, Yang M, Lai K, Ip CY, Lao L, Lin CC. Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial. Eur J Cancer Care (Engl) 2020; 31:e13314. [PMID: 32896014 DOI: 10.1111/ecc.13314] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment. METHODS Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy. RESULTS Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes. CONCLUSIONS Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.
Collapse
Affiliation(s)
- Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tai Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mingxiao Yang
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kithelia Lai
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Chun Yat Ip
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Virginia University of Integrative Medicine, Virginia, United States
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong, China.,School of Nursing, College of Nursing, Taipei Medical University, Taiwan
| |
Collapse
|
70
|
Gross O, Garabedian N, Richard C, Citrini M, Sannié T, Gagnayre R. Educational content and challenges encountered when training service user representatives as peer researchers in a mixed study on patient experience of hospital safety. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:50. [PMID: 32905210 PMCID: PMC7466417 DOI: 10.1186/s40900-020-00226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES In France, following the passing of a 2002 law, service user representatives (SURs) are part of hospital committees in charge of care quality and safety issues. Ten service user representatives (SURs) were recruited and trained as "peer researchers" to participate in all phases of a study aimed at outlining how patients experience hospital safety. This article aims to describe the study protocol and how peer researchers training was designed and implemented to prepare them to drive a qualitative and quantitative research. It also examines the challenges related to collaborative research and how these were resolved. METHODS The way our training was conceived belongs to the field of "design-based research", known for its pragmatic and collaborative scope, in which viewpoints of all participants are included. Our training was therefore based on peer researchers and research sponsors expectations, as well as on recommendations of the literature. RESULTS A 45-h training was held. While the program was meant to train peer researchers to respect scientific norms, it also aimed to improve their sense of self-legitimacy as they navigated their new role. Peer researchers were particularly eager to understand meaning behind the instructions, especially in the field of ethical and scientific norms. Various challenges occurred related to project organization, recruitment and peer researchers involvement. Some issues were overcome by learning how to share control over the research process. CONCLUSION This experiment highlights the importance of a training program's duration and quality to prepare SURs for their roles as peer investigators and to create a group dynamic around a research project, even with SURs familiar with patient involvement and our research theme (safety issues). Trainers overcame hurdles by being adaptive and by using educational approaches. They also learned to include trainees' input, even when it forced them to reconsider their own assumptions.
Collapse
Affiliation(s)
- O. Gross
- Health Education and Practices Laboratory (LEPS UR3412) University Sorbonne Paris Nord, 74 rue Marcel Cachin, 93017 Bobigny, France
| | - N. Garabedian
- Hôpital Necker-Enfants Malades, President of the medical board of Paris Universities Hospitals, Paris, France
| | - C. Richard
- Hôpital Bicêtre, Member of the medical board of Paris Universities Hospitals, Le Kremlin-Bicêtre, France
| | - M. Citrini
- AP-HP service user representative, Association Créteil Respire À Coeur (Society of respiratory diseases), 38, rue des Blancs Manteaux, 75004 Paris, France
| | - T. Sannié
- AP-HP service user representative, Association française des hémophiles (French Hemophiliacs Society), 6 rue Alexandre Cabanel, 75015 Paris, France
| | - R. Gagnayre
- Health Education and Practices Laboratory (LEPS UR3412) University Sorbonne Paris Nord, 74 rue Marcel Cachin, 93017 Bobigny, France
| |
Collapse
|
71
|
Jones AP, Clayton D, Nkhoma G, Sherratt FC, Peak M, Stones SR, Roper L, Young B, McErlane F, Moitt T, Ramanan AV, Foster HE, Williamson PR, Deepak S, Beresford MW, Baildam EM. Different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis: the SIRJIA mixed-methods feasibility study. Health Technol Assess 2020; 24:1-152. [PMID: 32758350 PMCID: PMC7443738 DOI: 10.3310/hta24360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the UK, juvenile idiopathic arthritis is the most common inflammatory disorder in childhood, affecting 10 : 100,000 children and young people aged < 16 years each year, with a population prevalence of around 1 : 1000. Corticosteroids are commonly used to treat juvenile idiopathic arthritis; however, there is currently a lack of consensus as to which corticosteroid induction regimen should be used with various disease subtypes and severities of juvenile idiopathic arthritis. OBJECTIVE The main study objective was to determine the feasibility of conducting a randomised controlled trial to compare the different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis. DESIGN This was a mixed-methods study. Work packages included a literature review; qualitative interviews with children and young people with juvenile idiopathic arthritis and their families; a questionnaire survey and screening log to establish current UK practice; a consensus meeting with health-care professionals, children and young people with juvenile idiopathic arthritis, and their families to establish the primary outcome; a feasibility study to pilot data capture and to collect data for future sample size calculations; and a final consensus meeting to establish the final protocol. SETTING The setting was rheumatology clinics across the UK. PARTICIPANTS Children, young people and their families who attended clinics and health-care professionals took part in this mixed-methods study. INTERVENTIONS This study observed methods of prescribing corticosteroids across the UK. MAIN OUTCOME MEASURES The main study outcomes were the acceptability of a future trial for children, young people, their families and health-care professionals, and the feasibility of delivering such a trial. RESULTS Qualitative interviews identified differences in the views of children, young people and their families on a randomised controlled trial and potential barriers to recruitment. A total of 297 participants were screened from 13 centres in just less than 6 months. In practice, all routes of corticosteroid administration were used, and in all subtypes of juvenile idiopathic arthritis. Intra-articular corticosteroid injection was the most common treatment. The questionnaire surveys showed the varying clinical practice across the UK, but established intra-articular corticosteroids as the treatment control for a future trial. The primary outcome of choice for children, young people, their families and health-care professionals was the Juvenile Arthritis Disease Activity Score, 71-joint count. However, results from the feasibility study showed that, owing to missing blood test data, the clinical Juvenile Arthritis Disease Activity Score should be used. The Juvenile Arthritis Disease Activity Score, 71-joint count, and the clinical Juvenile Arthritis Disease Activity Score are composite disease activity scoring systems for juvenile arthritis. Two final trial protocols were established for a future randomised controlled trial. LIMITATIONS Fewer clinics were included in this feasibility study than originally planned, limiting the ability to draw strong conclusions about these units to take part in future research. CONCLUSIONS A definitive randomised controlled trial is likely to be feasible based on the findings from this study; however, important recommendations should be taken into account when planning such a trial. FUTURE WORK This mixed-methods study has laid down the foundations to develop the evidence base in this area and conducting a randomised control trial to compare different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis is likely to be feasible. STUDY REGISTRATION Current Controlled Trials ISRCTN16649996. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 36. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Ashley P Jones
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Dannii Clayton
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Gloria Nkhoma
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | | | - Matthew Peak
- Alder Hey Children's NHS Foundation Trust, a member of the Liverpool Health Partners, Liverpool, UK
| | | | - Louise Roper
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Bridget Young
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Samundeeswari Deepak
- Paediatric Rheumatology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| | - Michael W Beresford
- Faculty of Health and Life Science, University of Liverpool and Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Eileen M Baildam
- Alder Hey Children's NHS Foundation Trust, a member of the Liverpool Health Partners, Liverpool, UK
| |
Collapse
|
72
|
Muir R, Carlini JJ, Harbeck EL, Gillespie BM, Tuffaha HW, Walker RM, McInnes EC, Latimer SL, Lin FF, Pearcy JM, Chaboyer WP. Patient involvement in surgical wound care research: A scoping review. Int Wound J 2020; 17:1462-1482. [PMID: 32537915 DOI: 10.1111/iwj.13395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022] Open
Abstract
Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this occurs in surgical wound care is not evident. This scoping review aimed to identify how patients have been involved in surgical wound care research and the quality of its reporting. Full-text studies focused on preoperative and postoperative surgical wound care in the acute care setting, published in English between 2004 and 2019, were included in the review. Screening, data charting, and quality assessment were conducted by two reviewers independently, adjudicated by a third, and then reviewed by five others. Thematic analysis synthesised the findings. Of the eight included studies, seven explained the methods for patient involvement and five described aims related to patient involvement and commented on patient involvement in the discussion. None met all of the quality assessment criteria. Three themes emerged: involvement in modifying and refining research processes, connecting and balancing expert and patient views, and sharing personal insights. Recommendations to improve patient involvement in surgical wounds research include the following: using framework and tools to inform future research; training researcher and patients in their respective research roles; and ongoing monitoring of patient involvement.
Collapse
Affiliation(s)
- Rachel Muir
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Joan Julie Carlini
- Department of Marketing, Griffith University, Gold Coast, Queensland, Australia.,Consumer Advisory Group, Gold Coast Health, Gold Coast, Queensland, Australia
| | | | - Brigid Mary Gillespie
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Haitham Wadah Tuffaha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Michell Walker
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Catherine McInnes
- Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Nursing Research Institute, St Vincent's Health Australia, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia.,School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Sharon Leanne Latimer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Frances Fengzhi Lin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | | | - Wendy Pearl Chaboyer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
73
|
Campbell LA, Lovas D, Withers E, Peacock K. Opening the door: inviting youth and parent perspectives on youth mental health emergency department use. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:26. [PMID: 32514374 PMCID: PMC7251901 DOI: 10.1186/s40900-020-00204-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/07/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Canadian Emergency Departments (EDs) have seen increasing use by children and youth for mental health concerns in recent years. This trend is likely a result of several complex factors, and researcher-posed potential explanations include gaps or access problems in primary care or mental health services, increasing prevalence or awareness of mental disorders and fear of potentially harmful outcomes, or expectations of need for urgent specialist care. Youth, parent, or caregiver perceptions and reasons for increasing mental health ED use may differ, and to date have been underrepresented in informing research directions. We sought to engage with youth and parents or caregivers served by a Canadian tertiary paediatric health centre to: 1) inform research directions for an emerging program of research in child and youth ED use for mental health care; and 2) develop strategies to support ongoing patient engagement in our research. METHODS Youth and parents were consulted to inform the development of a research engagement strategy. Partnerships with local community agencies facilitated supported engagement with both youth and parents. Group and individual in-person engagement opportunities were offered, as well as opportunities for written submissions and information sharing. RESULTS Youth and parents identified specific mechanisms to support engagement and for sharing ongoing opportunities and progress, including providing multiple platforms for engagement, offering separate opportunities for youth and parents or caregivers, and minimizing the potential for distress by ensuring appropriate supports and providing alternative opportunities for feedback, including written submissions. They identified lack of timely access to mental health care in primary care and community mental health settings, and accessibility, dependability, and familiarity of the ED as areas for further research. CONCLUSIONS Strategies to mitigate potential concerns regarding distress, readiness for participation, literacy, and protection of privacy were highlighted as important considerations. Youth and parents were interested in ongoing research engagement through consultation and information sharing. Youth and parents identified areas of interest for research and refined the research team's proposed research directions by adding contextualizing information. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Leslie Anne Campbell
- Dalhousie University Department of Community Health and Epidemiology, Halifax, Nova Scotia Canada
- Dalhousie University School of Nursing, Halifax, Nova Scotia Canada
- Department of Psychiatry, IWK Health Centre, Halifax, Nova Scotia Canada
| | - David Lovas
- Department of Psychiatry, IWK Health Centre, Halifax, Nova Scotia Canada
- Dalhousie University Department of Psychiatry, Halifax, Nova Scotia Canada
| | - Ellen Withers
- Dalhousie University Department of Community Health and Epidemiology, Halifax, Nova Scotia Canada
- Department of Psychiatry, IWK Health Centre, Halifax, Nova Scotia Canada
| | - Kylie Peacock
- Dalhousie University Department of Community Health and Epidemiology, Halifax, Nova Scotia Canada
- Dalhousie University School of Occupational Therapy, Halifax, Nova Scotia Canada
| |
Collapse
|
74
|
Aubin D, Hebert M, Eurich D. The importance of measuring the impact of patient-oriented research. CMAJ 2020; 191:E860-E864. [PMID: 31387956 DOI: 10.1503/cmaj.190237] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Diane Aubin
- Career Development in Methods and Health Services Research (Aubin, Hebert, Eurich), Alberta SPOR SUPPORT Unit; School of Public Health (Aubin, Eurich), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Hebert), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Marilynne Hebert
- Career Development in Methods and Health Services Research (Aubin, Hebert, Eurich), Alberta SPOR SUPPORT Unit; School of Public Health (Aubin, Eurich), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Hebert), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Dean Eurich
- Career Development in Methods and Health Services Research (Aubin, Hebert, Eurich), Alberta SPOR SUPPORT Unit; School of Public Health (Aubin, Eurich), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Hebert), Cumming School of Medicine, University of Calgary, Calgary, Alta
| |
Collapse
|
75
|
Ortiz K, Nash J, Shea L, Oetzel J, Garoutte J, Sanchez-Youngman S, Wallerstein N. Partnerships, Processes, and Outcomes: A Health Equity-Focused Scoping Meta-Review of Community-Engaged Scholarship. Annu Rev Public Health 2020; 41:177-199. [PMID: 31922931 PMCID: PMC8095013 DOI: 10.1146/annurev-publhealth-040119-094220] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.
Collapse
Affiliation(s)
- Kasim Ortiz
- Department of Sociology and Criminology, University of New Mexico, Albuquerque, New Mexico 87131, USA;
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Institute for the Study of "Race" and Social Justice, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Jacob Nash
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Logan Shea
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - John Oetzel
- Waikato Management School, University of Waikato, 3240 Hamilton, New Zealand
| | - Justin Garoutte
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Behavioral Health Research Center of the Southwest (BHRCS), Pacific Institute for Research and Evaluation (PIRE), Albuquerque, New Mexico 87106, USA
| | - Shannon Sanchez-Youngman
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Center for Social Policy, University of New Mexico, Albuquerque, New Mexico 87131, USA
- School of Public Administration, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Nina Wallerstein
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, New Mexico 87131, USA
| |
Collapse
|
76
|
Pelletier CA, Pousette A, Ward K, Fox G. Exploring the perspectives of community members as research partners in rural and remote areas. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:3. [PMID: 32015898 PMCID: PMC6990467 DOI: 10.1186/s40900-020-0179-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Community engagement in research has the potential to support the development of meaningful health promotion interventions to address health inequities. People living in rural and remote areas face increased barriers to participation in health research and may be unjustly excluded from participation. It is necessary to understand the process of patient and public engagement from the perspective of community members to support partnered research in underserved areas. The aim of this project was to increase understanding on how to include community members from rural and remote areas as partners on research teams. METHODS Using purposive sampling, we completed semi-structured interviews with a representative sample of 12 community members in rural and remote areas of northern British Columbia, Canada. Interviews were audio recorded and transcribed verbatim. Following an integrated knowledge translation approach, an inductive thematic analysis was completed to incorporate researcher and knowledge user perspectives. RESULTS The factors important to community members for becoming involved in research include: 1) relevance; 2) communication; and 3) empowering participation. The analysis suggests projects must be relevant to both communities and individuals. Most participants stated that they would not be interested in becoming partners on research projects that did not have a direct benefit or value for their communities. Participants expressed the need for clear expectations and clarification of preferred communication mechanisms. Communication must be regular, appropriate in length and content, and written in a language that is accessible. It is essential to ensure that community members are recognized as subject matter experts, to provide appropriate training on the research process, and to use research outcomes to support decision making. CONCLUSIONS To engage research partners in rural and remote communities, research questions and outcomes should be co-produced with community members. In-person relationships can help establish trust and bidirectional communication mechanisms are prudent throughout the research process, including the appropriate sharing of research findings. Although this project did not include community members as research team members or in the co-production of this research article, we present guidelines for research teams interested in adding a patient or public perspective to their integrated knowledge translation teams.
Collapse
Affiliation(s)
- Chelsea A. Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Anne Pousette
- Promotion of Wellness in Northern BC (WINBC), Clinical Faculty, Northern Medical Program, University of British Columbia, Medical Staff, University Hospital of Northern BC, Northern Health, Prince George, Canada
| | - Kirsten Ward
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
- Present address: Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Gloria Fox
- Population and Preventive Public Health, Northern Health, Prince George, Canada
| |
Collapse
|
77
|
Foster M, Fergusson DA, Hawrysh T, Presseau J, Kekre N, Schwartz S, Castillo G, Asad S, Fox G, Atkins H, Thavorn K, Montroy J, Holt RA, Monfaredi Z, Lalu MM. Partnering with patients to get better outcomes with chimeric antigen receptor T-cell therapy: towards engagement of patients in early phase trials. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:61. [PMID: 33072399 PMCID: PMC7557015 DOI: 10.1186/s40900-020-00230-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/06/2020] [Indexed: 05/03/2023]
Abstract
AIM Though patient engagement in clinical research is growing, recent reports suggest few clinical trials report on such activities. To address this gap, we describe our approach to patient engagement in the development of a clinical trial protocol to assess a new immunotherapy for blood cancer (chimeric antigen receptor T-cell therapy, CAR-T cell therapy). METHODS Our team developed a clinical trial protocol by working with patient partners from inception. Two patient partners with lived blood cancer experience were identified through referrals from our team's professional network and patient organization contacts. Our patient partners were onboarded to the team and engaged in several studies conducted to develop the clinical trial protocol, including a systematic review of the existing literature on the therapy, patient interviews and a survey to obtain perspectives on barriers and enablers to participating in the trial, an early economic analysis, and a retrospective cohort study. RESULTS Engaging patient partners enhanced our research in ways that would not have otherwise occurred. By selecting patient important outcomes for data collection, our partners helped flag that quality of life and health utility measures have not been reported in previous CAR-T cell therapy trials for blood cancer. Our partners also co-developed a non-technical summary of the systematic review that summarized results in an accessible manner. Our patient partners reviewed interview and survey questions, to improve the language and appropriateness; provided recruitment suggestions; and provided a patient perspective on the results, thereby confirming the importance of findings. Input was also obtained on costs for the early economic analysis. Our patient partners identified costs that may be a burden to both patients and caregivers during a trial and helped to confirm that the overall structure of the economic model reflected the patient care pathway. Our patient partners also shared their diagnosis and treatment stories, which helped to provide the research team with insight into this experience. CONCLUSIONS Contributions by our patient partners were invaluable to each component study, as well as the overall development of the trial protocol. We plan to use this approach in the future in order to meaningfully engage patients in the development of other clinical trials; we also hope that by reporting our methods this will help other research teams to do the same. TRIAL REGISTRATION Affiliated with the development of NCT03765177.
Collapse
Affiliation(s)
- Madison Foster
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- Blood and Marrow Transplant Program, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | | | - Gisell Castillo
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Sarah Asad
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Grace Fox
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Harold Atkins
- Blood and Marrow Transplant Program, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Institute for Clinical and Evaluative Sciences, ICES uOttawa, 1053 Carling Ave, Ottawa, ON K1Y 4E9 Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Robert A Holt
- BC Cancer Genome Sciences Centre, Canada’s Michael Smith Genome Sciences Centre, 570 W 7th Ave, Vancouver, BC V5Z 4S6 Canada
| | - Zarah Monfaredi
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- SPOR Program Facilitator, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- Department of Anesthesiology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| |
Collapse
|
78
|
Smits DW, van Meeteren K, Klem M, Alsem M, Ketelaar M. Designing a tool to support patient and public involvement in research projects: the Involvement Matrix. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:30. [PMID: 32550002 PMCID: PMC7296703 DOI: 10.1186/s40900-020-00188-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/26/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Interest in patient involvement in research is growing. Research should rather be 'with' or 'by' patients, and not only be 'about' or 'for' patients. Patients' active involvement in research is not self-evident and special efforts have to be made. If we make efforts towards patient involvement, it could contribute to even more relevant projects with an even greater impact. In this paper we describe the process of development of a tool to support patient involvement in research projects. METHODS The tool development was done in a co-creation of experience experts (patients and their parents/relatives) together with researchers. We used a participatory method in an iterative process comprising three consecutive stages. First, the purpose for the tool was explored, using focus groups. Second, the main ingredients and conceptualization for the tool were determined, using a narrative review. Third, the so-called Involvement Matrix was formalized and finalized using various expert panels. RESULTS A conversation tool was developed, through which researchers and patients could discuss and explain their roles of involvement in a research project. This tool was formalized and visualized as a 'matrix'. The so-called Involvement Matrix describes five roles (i.e., Listener, Co-thinker, Advisor, Partner, and Decision-maker) and three phases (i.e., Preparation, Execution, and Implementation) and includes a user's guide. CONCLUSION The Involvement Matrix can be used prospectively to discuss about possible roles of patients in different phases of projects, and retrospectively to discuss whether roles were carried out satisfactorily. Sharing experiences with the Involvement Matrix and evaluating its impact are the next steps in supporting patient involvement in research.
Collapse
Affiliation(s)
- Dirk-Wouter Smits
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- ‘Denker in Beweging’, Organization for Action Research Involving Parents and Children, Terheijden, the Netherlands
| | - Karen van Meeteren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- ‘OuderInzicht’, Parent Organization for Increasement of Parent Involvement in Research, Amsterdam, the Netherlands
| | - Martijn Klem
- BOSK, Association of People with congenital disabilities, Utrecht, the Netherlands
| | - Mattijs Alsem
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| |
Collapse
|
79
|
Jull JE, Davidson L, Dungan R, Nguyen T, Woodward KP, Graham ID. A review and synthesis of frameworks for engagement in health research to identify concepts of knowledge user engagement. BMC Med Res Methodol 2019; 19:211. [PMID: 31752691 PMCID: PMC6869315 DOI: 10.1186/s12874-019-0838-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Engaging those who influence, administer and/or who are active users ("knowledge users") of health care systems, as co-producers of health research, can help to ensure that research products will better address real world needs. Our aim was to identify and review frameworks of knowledge user engagement in health research in a systematic manner, and to describe the concepts comprising these frameworks. METHODS An international team sharing a common interest in knowledge user engagement in health research used a consensus-building process to: 1) agree upon criteria to identify articles, 2) screen articles to identify existing frameworks, 3) extract, analyze data, and 4) synthesize and report the concepts of knowledge user engagement described in health research frameworks. We utilized the Patient Centered Outcomes Research Institute Engagement in Health Research Literature Explorer (PCORI Explorer) as a source of articles related to engagement in health research. The search includes articles from May 1995 to December 2017. RESULTS We identified 54 articles about frameworks for knowledge user engagement in health research and report on 15 concepts. The average number of concepts reported in the 54 articles is n = 7, and ranges from n = 1 to n = 13 concepts. The most commonly reported concepts are: knowledge user - prepare, support (n = 44), relational process (n = 39), research agenda (n = 38). The least commonly reported concepts are: methodology (n = 8), methods (n = 10) and analysis (n = 18). In a comparison of articles that report how research was done (n = 26) versus how research should be done (n = 28), articles about how research was done report concepts more often and have a higher average number of concepts (n = 8 of 15) in comparison to articles about how research should be done (n = 6 of 15). The exception is the concept "evaluate" and that is more often reported in articles that describe how research should be done. CONCLUSIONS We propose that research teams 1) consider engagement with the 15 concepts as fluid, and 2) consider a form of partnered negotiation that takes place through all phases of research to identify and use concepts appropriate to their team needs. There is a need for further work to understand concepts for knowledge user engagement.
Collapse
Affiliation(s)
- Janet E Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street, Louise D. Acton Building, Kingston, Ontario, Canada. .,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.
| | - Laurie Davidson
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Rachel Dungan
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Tram Nguyen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Krista P Woodward
- Public and Patient Engagement Department, Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Washington D.C., 20008, USA
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
80
|
Vat LE, Finlay T, Jan Schuitmaker-Warnaar T, Fahy N, Robinson P, Boudes M, Diaz A, Ferrer E, Hivert V, Purman G, Kürzinger ML, Kroes RA, Hey C, Broerse JEW. Evaluating the "return on patient engagement initiatives" in medicines research and development: A literature review. Health Expect 2019; 23:5-18. [PMID: 31489988 PMCID: PMC6978865 DOI: 10.1111/hex.12951] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/02/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022] Open
Abstract
Background Showing how engagement adds value for all stakeholders can be an effective motivator for broader implementation of patient engagement. However, it is unclear what methods can best be used to evaluate patient engagement. This paper is focused on ways to evaluate patient engagement at three decision‐making points in the medicines research and development process: research priority setting, clinical trial design and early dialogues with regulators and health technology assessment bodies. Objective Our aim was to review the literature on monitoring and evaluation of patient engagement, with a focus on indicators and methods. Search strategy and inclusion criteria We undertook a scoping literature review using a systematic search, including academic and grey literature with a focus on evaluation approaches or outcomes associated with patient engagement. No date limits were applied other than a cut‐off of publications after July 2018. Data extraction and synthesis Data were extracted from 91 publications, coded and thematically analysed. Main results A total of 18 benefits and 5 costs of patient engagement were identified, mapped with 28 possible indicators for their evaluation. Several quantitative and qualitative methods were found for the evaluation of benefits and costs of patient engagement. Discussion and conclusions Currently available indicators and methods are of some use in measuring impact but are not sufficient to understand the pathway to impact, nor whether interaction between researchers and patients leads to change. We suggest that the impacts of patient engagement can best be determined not by applying single indicators, but a coherent set of measures.
Collapse
Affiliation(s)
- Lidewij Eva Vat
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
| | | | | | | | | | | | | | | |
Collapse
|
81
|
Abstract
The health research landscape is changing, and it is time for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) community to foster authentic opportunities for patient engagement in musculoskeletal research and practice. Although authentic engagement has challenges, the benefits are well worth the investment of time and energy to overcome these challenges and improve the quality of physical therapy research. In this editorial, the authors outline 3 steps JOSPT is taking to promote and support patient partnership in musculoskeletal research. J Orthop Sports Phys Ther 2019;49(9):623-626. doi:10.2519/jospt.2019.0106.
Collapse
|
82
|
Anstey A, Popli U, Hughes C. Patient engagement with the
BJD
: why and how? Br J Dermatol 2019; 180:1274-1276. [DOI: 10.1111/bjd.17847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A.V. Anstey
- Betsi Cadwaladr University Health Board Bangor Gwynedd U.K
| | - U. Popli
- Betsi Cadwaladr University Health Board Bangor Gwynedd U.K
| | - C.L. Hughes
- Patient Panel Centre for Evidence Based Dermatology Nottingham U.K
- Cochrane Skin Group Nottingham U.K
| |
Collapse
|
83
|
Tambor E, Shalowitz M, Harrington JM, Hull K, Watson N, Sital S, Al Naber J, Miller D. Engaging patients, clinicians, and the community in a Clinical Data Research Network: Lessons learned from the CAPriCORN CDRN. Learn Health Syst 2019; 3:e10079. [PMID: 31245603 PMCID: PMC6508783 DOI: 10.1002/lrh2.10079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/08/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022] Open
Abstract
Engaging patients, clinicians, and community members in the development of a research network creates opportunities and challenges beyond engagement in discrete learning activities. This paper describes our experiences establishing and maintaining a stakeholder engagement infrastructure for the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) and highlights important lessons learned over the first 4 years. During this time, the CAPriCORN Patient and Community Advisory Committee (PCAC) appointed patient, clinician, and community representatives to governance and advisory groups throughout the network, developed a process and criteria for patient- and clinician-centered review of research proposals, and evolved from a large, diverse group to a smaller yet still diverse, more actively engaged group with connections to the broader community. Key challenges faced by the PCAC have included determining the optimal size and composition of the group, understanding the complex structure of the network as a whole, coordinating with other network entities and functions, and integrating the patient and community voice into the research review process. Efforts to engage stakeholders in clinical data research networks should anticipate and develop solutions to address these challenges.
Collapse
Affiliation(s)
- Ellen Tambor
- Center for Medical Technology PolicyBaltimoreMDUSA
| | | | | | - Kevin Hull
- West Side Institute for Science and Education, at the Jesse Brown VA Medical CenterChicagoILUSA
| | - Natalie Watson
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
| | - Shelly Sital
- Chicago Area Patient‐Centered Outcomes Research Network (CAPriCORN)ChicagoILUSA
| | | | - Doriane Miller
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
| |
Collapse
|
84
|
Deane K, Delbecque L, Gorbenko O, Hamoir AM, Hoos A, Nafria B, Pakarinen C, Sargeant I, Richards DP, Skovlund SE, Brooke N. Co-creation of patient engagement quality guidance for medicines development: an international multistakeholder initiative. ACTA ACUST UNITED AC 2019; 5:43-55. [PMID: 31645992 PMCID: PMC6792320 DOI: 10.1136/bmjinnov-2018-000317] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 01/20/2023]
Abstract
Introduction Meaningful patient engagement (PE) can enhance medicines' development. However, the current PE landscape is fragmentary and lacking comprehensive guidance. Methods We systematically searched for PE initiatives (SYNaPsE database/publications). Multistakeholder groups integrated these with their own PE expertise to co-create draft PE Quality Guidance which was evaluated by public consultation. Projects exemplifying good PE practice were identified and assessed against PE Quality Criteria to create a Book of Good Practices (BOGP). Results Seventy-six participants from 51 organisations participated in nine multistakeholder meetings (2016-2018). A shortlist of 20relevant PE initiatives (from 170 screened) were identified. The co-created INVOLVE guidelines provided the main framework for PE Quality Guidance and was enriched with the analysis of the PE initiatives and the PE expertise of stakeholders. Seven key PE Quality Criteria were identified. Public consultation yielded 67 responses from diverse backgrounds. The PE Quality Guidance was agreed to be useful for achieving quality PE in practice, understandable, easy to use, and comprehensive. Overall, eight initiatives from the shortlist and from meeting participants were selected for inclusion in the BOGP based on demonstration of PE Quality Criteria and willingness of initiative owners to collaborate. Discussion The PE Quality Guidance and BOGP are practical resources which will be continually updated in response to user feedback. They are not prescriptive, but rather based on core principles, which can be applied according to the unique needs of each interaction and initiative. Implementation of the guidance will facilitate improved and systematic PE across the medicines' development lifecycle.
Collapse
Affiliation(s)
- Katherine Deane
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laure Delbecque
- Patient Reported Outcomes, Pharmerit International, Rotterdam, Belgium
| | - Oleksandr Gorbenko
- Chief Scientific and Medical Office - Patient Affairs, ViiV Healthcare, London, UK
| | | | - Anton Hoos
- Patient Focused Medicines Development, Brussels, Belgium
| | - Begonya Nafria
- Patient Engagement in Research, Institut de Recerca Sant Joan de Déu- Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Chi Pakarinen
- Patient Focused Medicines Development, Brussels, Belgium
| | - Ify Sargeant
- Patient Focused Medicines Development, Brussels, Belgium
| | | | - Soren Eik Skovlund
- Steno Diabetes Centre North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | | |
Collapse
|
85
|
Kendall C, Fitzgerald M, Kang RS, Wong ST, Katz A, Fortin M, Dionne E, Kuluski K, O'Brien MA, Ploeg J, Crowe L, Liddy C. "Still learning and evolving in our approaches": patient and stakeholder engagement among Canadian community-based primary health care researchers. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:47. [PMID: 30524753 PMCID: PMC6276251 DOI: 10.1186/s40900-018-0132-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/14/2018] [Indexed: 05/15/2023]
Abstract
PLAIN ENGLISH SUMMARY Increasingly, health researchers are conducting their research in partnership with non-researchers such as patients and caregivers, advocacy groups, clinicians, and policymakers. The idea behind this partnership is to make research more relevant and appropriate. However, so far there is not much evidence about how this partnership or engagement actually affects research. We conducted an online survey of 12 teams in Canada that have engaged patients and other stakeholders in community based health research, partly as a requirement to obtain funding. We found that in many cases, the teams have engaged a wide variety and large number of stakeholders, and have involved them in many different stages of their research. Teams reported that their overall experience of this approach to research has been positive, but some challenges have been encountered along the way. Some teams found that it was difficult to communicate appropriately with all the stakeholders, and to keep them informed when research was going slowly. Other teams had trouble finding government representatives to work with. Several teams noted that engagement is time-consuming, and requires a lot of effort. Nevertheless, all teams reported that they had learned from the experience, and found it valuable. As a result, Canadian health care researchers are better positioned to engage with patients and other stakeholders in the future. ABSTRACT Background Patient and other stakeholder engagement in research is increasingly important, but there is limited evidence of its impact. In 2013, the Canadian Institutes of Health Research launched a five-year Community Based Primary Health Care (CBPHC) initiative that funded 12 teams for innovative approaches to primary health care involving engagement with patients, communities, decision-makers, and clinicians across jurisdictions in Canada. The present study examines the extent of engagement by these teams, and the factors that affected it, either as challenges or opportunities. Methods We conducted a cross-sectional web-based survey across the 12 CBPHC Innovation Teams, in which we were also participants. We used a data collection tool developed by the Patient Centered Outcomes Research Institute that included both closed and open-ended questions. Results The quantitative data showed that the CBPHC Innovation teams have engaged with diverse stakeholders at different levels and in different stages of research. Almost all teams surveyed engaged with policymakers, most with clinicians and health system representatives, and more than half with patients, mostly at the level of consultation or collaboration. There were very few instances of stakeholder-led research reported. There was a near universal recognition of the importance of communications processes/tools in facilitating engagement, whereas time was the most commonly identified challenge. In almost all cases, challenges encountered were partially if not fully resolved.The qualitative findings showed that each team's engagement was contextualized by factors such as the jurisdictions and geographic scope of the project, the number and type of stakeholders engaged and their level of involvement. These intersected with the researchers' motivations for engagement, to give rise to diverse experiences, but ones that the CBPHC teams assessed positively as an approach to research. Conclusions Over the past five years, primary health care researchers in Canada have been actively engaging with patients and other stakeholders. The wide range, extent and nature of that engagement shows that these researchers have anticipated developments in this approach to research and are thus in a position to support and strengthen future efforts to understand the impact of this engagement on health care outcomes.
Collapse
Affiliation(s)
- Claire Kendall
- 1C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON Canada
- 2Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- 3Institute for Clinical Evaluative Sciences (IC/ES), Toronto, ON Canada
- 4Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON Canada
- 5Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Michael Fitzgerald
- 1C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON Canada
| | | | - Sabrina T Wong
- 7School of Nursing, University of British Columbia, Vancouver, BC Canada
- 8Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Alan Katz
- 9Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- 10Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- 11Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Martin Fortin
- 12Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Chicoutimi, QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac St-Jean, Chicoutimi, QC Canada
| | - Emilie Dionne
- 14St. Mary's Research Centre & Department of Family Medicine, McGill University, Montreal, QC Canada
| | - Kerry Kuluski
- 15Bridgepoint Collaboratory of the Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON Canada
- 16Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Mary Ann O'Brien
- 17Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Jenny Ploeg
- 18School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- 19Department of Health, Aging and Society, Faculty of Social Sciences, McMaster University, Hamilton, ON Canada
- 20McMaster Institute for Research on Aging, McMaster University, Hamilton, ON Canada
- 21Aging, Community and Health Research Unit, McMaster University, Hamilton, ON Canada
| | - Lois Crowe
- 1C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON Canada
| | - Clare Liddy
- 1C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON Canada
- 22Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| |
Collapse
|
86
|
Jull J, Petticrew M, Kristjansson E, Yoganathan M, Petkovic J, Tugwell P, Welch V. Engaging knowledge users in development of the CONSORT-Equity 2017 reporting guideline: a qualitative study using in-depth interviews. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:34. [PMID: 30377540 PMCID: PMC6196421 DOI: 10.1186/s40900-018-0118-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Randomized controlled trials ("randomized trials") can provide evidence to assess the equity impact of an intervention. Decision makers need to know about equity impacts of healthcare interventions so that people get healthcare that is best for them. To better understand the equity impacts of healthcare interventions, a range of people who were potentially the ultimate users of research results were involved in a six-phase project to extend the CONsolidated Standards Of Reporting Trials Statement for health equity ("CONSORT-Equity 2017"). We identified these "knowledge users" as: patients and healthcare researchers, decision makers and providers. This paper reports on one project phase: specifically, a qualitative study designed to integrate the expertise of knowledge users. The experiences and perspectives of knowledge users provided many insights about the reporting of health equity issues in randomized trials. This paper describes key informant interviews with knowledge users that contribute to a better understanding of the effects of an intervention on health equity. Additionally, the paper shows how these insights were used to develop CONSORT-Equity 2017. METHODS A qualitative study that used the framework analysis method was conducted in collaboration with an international study executive and advisory board team. In-depth semi-structured interviews were conducted with a purposive sample of key informants who: consider the research ethics of, fund, conduct, participate in, publish, or use research evidence generated in randomized trials. Transcripts were coded and analyzed using the seven-stage framework analysis method, and data reported to reflect knowledge user suggestions to develop CONSORT-Equity 2017. RESULTS Thirteen key informants, of which three were patients, chose to participate in interviews. Seven themes emerged: "Differentiate the type of trial", "Prompts for health equity", "Ethics matter", "Describe unique research strategies", "Clarity of reporting", "Implications of equity for sampling and analysis", "Think beyond the immediate trial". The interviews provided direction for the extension of 16 CONSORT-Equity 2017 items. CONCLUSIONS Key informant interviews were used to identify new concepts that were not generated in our other studies and to develop CONSORT-Equity 2017. We encourage the use of key informant interviews in guideline development to obtain and include the real-life expertise of knowledge users.
Collapse
Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario Canada
- Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Ontario Canada
| | - Mark Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Elizabeth Kristjansson
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, Ontario Canada
| | - Manosila Yoganathan
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Vivian Welch
- Methods Centre, Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, Ottawa, Ontario Canada
| | | |
Collapse
|