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Knight Lozano R, Shannon H, Gilby J, Goddard S, Turner L, Marsden J. Community-based respiratory health measures in children and young people with cerebral palsy: A scoping review. Dev Med Child Neurol 2024; 66:849-862. [PMID: 38269611 DOI: 10.1111/dmcn.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To identify, map, and describe outcome measurement domains and instruments used within a community setting to assess respiratory health in children and young people aged 1 to 18 years, diagnosed with cerebral palsy (CP). METHOD A scoping review methodology informed structured searches in nine databases, grey literature, and registries, conducted in August 2021 (updated in February 2023). Articles were screened for eligibility by two independent researchers. Any outcome measurement instruments used to assess respiratory health or associated impact were extracted, categorized, and mapped to health and health-related domains of the International Classification of Functioning, Disability, and Health. RESULTS Seventy-six outcome measurement instruments were identified across 78 articles worldwide between 1970 and 2023. These were categorized into 'Body functions and structures' (n = 20), 'Activity and performance' (n = 22), and 'Participation and quality of life' (n = 19), with a further 15 mapped to 'Health care resources use'. INTERPRETATION No consensus of 'what' to measure and 'how' to measure respiratory health in children and young people with CP was found. Moreover, many measures were not replicable in individuals with more severe forms of CP, excluding those at increased risk of respiratory-related morbidity and mortality. Further research is required to agree important outcome domains and associated measures in research and clinical practice. WHAT THIS PAPER ADDS A limited number and size of experimental designs were found. Seventy-six measures were identified to assess respiratory health in cerebral palsy. No consensus was found in 'what' or 'how' to measure respiratory health. Many measures were not replicable in children and young people at risk of poorer respiratory health outcomes. Children and young people with comorbidities and learning disability were frequently excluded from studies.
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Affiliation(s)
| | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sian Goddard
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Leanne Turner
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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Gill PJ, Buchanan F, Fahim C, Borkhoff CM, Raza S, Buba M, Wahi G, Bayliss A, Zhou K, Kanani R, Sakran M, De Castris-Garcia K, Barrowman N, Klassen T, Schuh S, Hulst J, Straus S, Macarthur C, Sozer A, Elwyn G, Breen-Reid K, Mahant S. Parenteral versus enteral fluids for infants hospitalized with bronchiolitis: The PREFER shared decision-making prospective observational study protocol. J Hosp Med 2024. [PMID: 38923338 DOI: 10.1002/jhm.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Incorporating shared decision-making (SDM) with children and families in hospitals was a top priority identified by patients, caregivers, and clinicians. Bronchiolitis, a common and costly reason for hospitalization in children, is an exemplar condition to study SDM in hospitals. Internationally, clinical practice guidelines differ when recommending intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids for hospitalized infants with bronchiolitis who are unsafe to be fed orally. While evidence indicates that either IV or NG fluids are safe and effective, parent involvement in SDM in selecting IV or NG fluids is unknown. Our aim is to generate knowledge of SDM with parents in choosing between IV or NG fluids and the benefits and harms of these two treatment options for hospitalized children with bronchiolitis. METHOD This is a multicenter, prospective, observational study, including children aged <12 months admitted to hospital with bronchiolitis requiring supplemental IV or NG fluids. The primary outcome will evaluate the extent of SDM in choosing IV versus NG fluids using the validated CollaboRATE tool. Secondary outcomes include the proportion of parents provided a choice of IV versus NG fluids; parent knowledge of fluid therapy; rate of fluids; length of hospital stay; and complications. DISCUSSION This study will evaluate the extent of SDM in hospitalized infants with bronchiolitis who require IV or NG fluids and will evaluate both patient-centered and clinical outcomes that are relevant to clinical practice.
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Affiliation(s)
- Peter J Gill
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Francine Buchanan
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Christine Fahim
- Implementation, Evaluation and Sustainability, Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Shamama Raza
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Buba
- Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Department of Paediatrics, Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada
| | - Kim Zhou
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Lakeridge Health, Oshawa, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Kim De Castris-Garcia
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Terry Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne Schuh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessie Hulst
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Straus
- Implementation, Evaluation and Sustainability, Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Colin Macarthur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Aubrey Sozer
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Karen Breen-Reid
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
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AlMail A, Jamjoom A, Pan A, Feng MY, Chau V, D'Gama AM, Howell K, Liang NSY, McTague A, Poduri A, Wiltrout K, Bassett AS, Christodoulou J, Dupuis L, Gill P, Levy T, Siper P, Stark Z, Vorstman JAS, Diskin C, Jewitt N, Baribeau D, Costain G. Consensus reporting guidelines to address gaps in descriptions of ultra-rare genetic conditions. NPJ Genom Med 2024; 9:27. [PMID: 38582909 PMCID: PMC10998895 DOI: 10.1038/s41525-024-00408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/27/2024] [Indexed: 04/08/2024] Open
Abstract
Genome-wide sequencing and genetic matchmaker services are propelling a new era of genotype-driven ascertainment of novel genetic conditions. The degree to which reported phenotype data in discovery-focused studies address informational priorities for clinicians and families is unclear. We identified reports published from 2017 to 2021 in 10 genetics journals of novel Mendelian disorders. We adjudicated the quality and detail of the phenotype data via 46 questions pertaining to six priority domains: (I) Development, cognition, and mental health; (II) Feeding and growth; (III) Medication use and treatment history; (IV) Pain, sleep, and quality of life; (V) Adulthood; and (VI) Epilepsy. For a subset of articles, all subsequent published follow-up case descriptions were identified and assessed in a similar manner. A modified Delphi approach was used to develop consensus reporting guidelines, with input from content experts across four countries. In total, 200 of 3243 screened publications met inclusion criteria. Relevant phenotypic details across each of the 6 domains were rated superficial or deficient in >87% of papers. For example, less than 10% of publications provided details regarding neuropsychiatric diagnoses and "behavioural issues", or about the type/nature of feeding problems. Follow-up reports (n = 95) rarely contributed this additional phenotype data. In summary, phenotype information relevant to clinical management, genetic counselling, and the stated priorities of patients and families is lacking for many newly described genetic diseases. The PHELIX (PHEnotype LIsting fiX) reporting guideline checklists were developed to improve phenotype reporting in the genomic era.
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Affiliation(s)
- Ali AlMail
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Program in Genetics & Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - Ahmed Jamjoom
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amy Pan
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Min Yi Feng
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Vann Chau
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Alissa M D'Gama
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Katherine Howell
- Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nicole S Y Liang
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, ON, Canada
| | - Amy McTague
- Department of Neurology, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Kimberly Wiltrout
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Anne S Bassett
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Lucie Dupuis
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Gill
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Tess Levy
- Division of Psychiatry, Ichan School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paige Siper
- Division of Psychiatry, Ichan School of Medicine at Mount Sinai, New York City, NY, USA
| | - Zornitza Stark
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Melbourne, VIC, Australia
| | - Jacob A S Vorstman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Catherine Diskin
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Natalie Jewitt
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Danielle Baribeau
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
| | - Gregory Costain
- Program in Genetics & Genome Biology, SickKids Research Institute, Toronto, ON, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, ON, Canada.
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Gentilini A, Miraldo M. The role of patient organisations in research and development: Evidence from rare diseases. Soc Sci Med 2023; 338:116332. [PMID: 37866173 DOI: 10.1016/j.socscimed.2023.116332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
Patient organisations play an increasingly crucial role in the pharmaceutical sector, yet their impact on innovation remains unexplored. We estimate the impact of patient organisations on R&D activity in the context of rare diseases in Europe using a proprietary dataset that maps clinical trials from discovery to phase III across 29 countries, 1893 indications, and 30 years (1990-2019). By applying difference-in-differences and event study methodologies to a panel of 1,646,910 unique R&D observations, we find that country-indication pairs with at least one operating patient organisation have a higher rate of R&D activity compared to those without, with stronger effect in more prevalent rare diseases compared to ultra-rare conditions. We observe a lag in effects from patient organisation introduction, suggesting it takes approximately five years for these organisations to affect R&D activity. Overall, our work suggests that patient organisations play an important role in steering R&D efforts in rare diseases. Further research is needed to better understand mechanisms driving this effect and the potential impact of patient organisations on existing health inequities.
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Affiliation(s)
- Arianna Gentilini
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Marisa Miraldo
- Department of Economics and Public Policy, Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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Marino LV, Collaḉo N, Coyne S, Leppan M, Ridgeway S, Bharucha T, Cochrane C, Fandinga C, Palframan K, Rees L, Osman A, Johnson MJ, Hurley-Wallace A, Darlington ASE. The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project. Healthcare (Basel) 2023; 11:2706. [PMID: 37893780 PMCID: PMC10606263 DOI: 10.3390/healthcare11202706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicole Collaḉo
- School of Health Sciences, Southampton University, Southampton SO17 1BJ, UK
| | | | | | | | - Tara Bharucha
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Colette Cochrane
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Catarina Fandinga
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Karla Palframan
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Leanne Rees
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahmed Osman
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mark J Johnson
- Neonatal Medicine, Princess Anne Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
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Do V, Buchanan F, Gill P, Nicholas D, Wahi G, Bismilla Z, Coffey M, Zhou K, Bayliss A, Selliah P, Sappleton K, Mahant S. Exploring the lived experience of patients and families who speak language other than English (LOE) for healthcare: developing a qualitative study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:49. [PMID: 37430365 DOI: 10.1186/s40900-023-00465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Patients who use Languages other than English (LOE) for healthcare communication in an English-dominant region are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in pediatric hospitals. Despite the knowledge that individuals who speak LOE have worse health outcomes, they are often excluded from research studies on the basis of language and there is a paucity of data on ways to address these known disparities. Our work aims to address this gap by generating knowledge to improve health outcomes for children with illness and their families with LEP. BODY: We describe an approach to developing a study with individuals marginalized due to using LOE for healthcare communication, specifically using semi-structured qualitative interviews. The premise of this study is participatory research-our overall goal with this systematic inquiry is to, in collaboration with patients and families with LOE, set an agenda for creating actionable change to address the health information disparities these patients and families experience. In this paper we describe our overarching study design principles, a collaboration framework in working with different stakeholders and note important considerations for study design and execution. CONCLUSIONS We have a significant opportunity to improve our engagement with marginalized populations. We also need to develop approaches to including patients and families with LOE in our research given the health disparities they experience. Further, understanding lived experience is critical to advancing efforts to address these well-known health disparities. Our process to develop a qualitative study protocol can serve as an example for engaging this patient population and can serve as a starting point for other groups who wish to develop similar research in this area. Providing high-quality care that meets the needs of marginalized and vulnerable populations is important to achieving an equitable, high-quality health care system. Children and families who use a Language other than English (LOE) in English dominant regions for healthcare have worse health outcomes including a significantly increased risk of experiencing adverse events, longer lengths of stay in hospital settings, and receiving more unnecessary tests and investigations. Despite this, these individuals are often excluded from research studies and the field of participatory research has yet to meaningfully involve them. This paper aims to describe an approach to conducting research with a marginalized population of children and families due to using a LOE. We detail protocol development for a qualitative study exploring the lived experiences of patients and families who use a LOE during hospitalization. We aim to share considerations when conducting research within this population of families with LOE. We highlight learning applied from the field of patient-partner and child and family-centred research and note specific considerations for those with LOE. Developing strong partnerships and adopting a common set of research principles and collaborative framework underlies our approach and initial learnings, which we hope spark additional work in this area.
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Affiliation(s)
- Victor Do
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Francine Buchanan
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Gill
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Alberta, Canada
| | - Gita Wahi
- Division of General Pediatrics, Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Zia Bismilla
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Maitreya Coffey
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kim Zhou
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, North York General Hospital, Toronto, ON, Canada
| | - Ann Bayliss
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Children's Health Division, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Karen Sappleton
- Centre for Innovation and Excellence in Child and Family-Centred Care, Hospital for Sick Children, Toronto, ON, Canada
| | - Sanjay Mahant
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Gill P. Interview: Peter Gill. EUROPEAN MEDICAL JOURNAL 2023. [DOI: 10.33590/emj/10302169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Peter Gill
- Staff Paediatrician and Associate Scientist, The Hospital for Sick Children and SickKids Research Institute, Toronto, Canada; Assistant Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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Patel SJ, Khan A, Bass EJ, Graham D, Baird J, Anderson M, Calaman S, Cray S, Destino L, Fegley A, Goldstein J, Johnson T, Kocolas I, Lewis KD, Liss I, Markle P, O'Toole JK, Rosenbluth G, Srivastava R, Vara T, Landrigan CP, Spector ND, Knighton AJ. Family, nurse, and physician beliefs on family-centered rounds: A 21-site study. J Hosp Med 2022; 17:945-955. [PMID: 36131598 PMCID: PMC10087029 DOI: 10.1002/jhm.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Variation exists in family-centered rounds (FCR). OBJECTIVE We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts. DESIGNS, SETTINGS AND PARTICIPANTS Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study. INTERVENTION We inquired about rounding beliefs/attitudes, practices, and demographics using a 26-question survey coproduced with family/nurse/attending-physician collaborators, informed by prior research and the Consolidated Framework for Implementation Research. MAIN OUTCOME AND MEASURES Out of 2578 individuals, 1647 (64%) responded to the survey; of these, 1313 respondents participated in FCR and were included in analyses (616 patients/families, 243 nurses, 285 resident physicians, and 169 attending physicians). Beliefs/attitudes regarding the importance of FCR elements varied by role, with resident physicians rating the importance of several FCR elements lower than others. For example, on adjusted multivariable analysis, attending physicians (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.8) and nurses (OR 3.1, 95% CI 1.3-7.4) were much more likely than resident physicians to report family participation on rounds as very/extremely important. Clinician support for key FCR elements was higher than self-reported practice (e.g., 88% believed family participation was important on rounds; 68% reported it often/always occurred). In practice, key elements of FCR were reported to often/always occur only 23%-70% of the time. RESULT Support for nurse and family participation in FCR is high among clinicians but varies by role. Physicians, particularly resident physicians, endorse several FCR elements as less important than nurses and patients/families. The gap between attitudes and practice and between clinician types suggests that attitudinal, structural, and cultural barriers impede FCR.
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Affiliation(s)
- Shilpa J Patel
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
| | - Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen J Bass
- Department of Information Science in the College of Computing and Informatics, Department of Health Systems and Sciences Research in the College of Nursing & Health Professions, School of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dionne Graham
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Michele Anderson
- Family-Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Sharon Calaman
- Division of Pediatric Critical Care, Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health/Hassenfeld Children's Hospital, New York City, New York, USA
| | - Sharon Cray
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Lauren Destino
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford/Stanford School of Medicine, Palo Alto, California, USA
| | - April Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Jenna Goldstein
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler Johnson
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Irene Kocolas
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
| | - Kheyandra D Lewis
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Isabella Liss
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peggy Markle
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, California, USA
| | - Raj Srivastava
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Tiffany Vara
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nancy D Spector
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- The Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania, USA
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
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