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Baumann LA, Reinhold AK, Brütt AL. Public and patient involvement in health policy decision-making on the health system level – A scoping review. Health Policy 2022; 126:1023-1038. [DOI: 10.1016/j.healthpol.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
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2
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Wilson MG, Nidumolu A, Berditchevskaia I, Gauvin FP, Abelson J, Lavis JN. Identifying approaches for synthesizing and summarizing information to support informed citizen deliberations in health policy: a scoping review. J Health Serv Res Policy 2019; 25:59-66. [PMID: 31523997 DOI: 10.1177/1355819619872221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Public deliberations are an increasingly popular tool to engage citizens in the development of health policies and programmes. However, limited research has been conducted on how to best synthesize and summarize information on health policy issues for citizens. To begin to address this gap, our aim was to map the literature on the preparation of information to support informed citizen deliberations related to health policy issues. Methods We conducted a scoping review where two reviewers screened the results of electronic database searches, grey literature searches and hand searches of organizational websites to identify empirical studies, scholarly commentaries, and publicly available organizational documents focused on synthesizing and summarizing information to inform citizen deliberation about health policy issues. Two reviewers categorized each included document according to themes/topics of deliberation, purpose of deliberation and the form of deliberation, and developed a summary of the key findings related to synthesizing and summarizing information to support informed citizen deliberations. Results There was limited reporting about whether and how information was synthesized. Evidence was typically organized based on the source used (e.g. by comparing the views of stakeholders or experts) or according to the areas that policymakers need to consider when making decisions (e.g. benefits, harms, costs and stakeholder perspectives related to policy options). Information was presented primarily through written materials (e.g. briefs and brochures), audiovisual resources (e.g. videos or presentations from stakeholders), but some interactive presentation approaches were also identified (e.g. through interactive arts-based approaches). Conclusions The choice and framing of information to inform citizen deliberations about health policy can strongly influence their understanding of a policy issue, and has the potential to impact the discussions and recommendations that emerge from deliberations. Our review confirmed that there remains a dearth of literature describing methods of the preparation of information to inform citizen deliberations about health policy issues. This highlights the need for further exploration of optimal strategies for citizen-friendly approaches to synthesizing and summarizing information for deliberations.
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Affiliation(s)
- Michael G Wilson
- Assistant Director, McMaster Health Forum, McMaster University, Canada.,Associate Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Member, Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - Aditya Nidumolu
- Resident Physician, Department of Psychiatry, Dalhousie University, Canada
| | | | - Francois-Pierre Gauvin
- Senior Scientific Lead, Citizen Engagement and Evidence Curation, McMaster Health Forum, McMaster University, Canada
| | - Julia Abelson
- Associate Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Professor, Department of Health Evidence and Impact, McMaster University, Canada
| | - John N Lavis
- Member, Centre for Health Economics and Policy Analysis, McMaster University, Canada.,Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Director, McMaster Health Forum, McMaster University, Canada.,Associate Member, Department of Political Science, McMaster University, Canada
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Rajan D, Mathurapote N, Putthasri W, Posayanonda T, Pinprateep P, de Courcelles S, Bichon R, Ros E, Delobre A, Schmets G. Institutionalising participatory health governance: lessons from nine years of the National Health Assembly model in Thailand. BMJ Glob Health 2019; 4:e001769. [PMID: 31478018 PMCID: PMC6703293 DOI: 10.1136/bmjgh-2019-001769] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/15/2019] [Indexed: 11/13/2022] Open
Abstract
Improving health governance is increasingly recognised as a key pillar for achieving universal health coverage (UHC). One good practice example of a participatory health governance platform is the National Health Assembly (NHA) in Thailand. This review of 9 years of the Thai NHA process attempted to understand how it works, given the paucity of such mechanisms worldwide. In addition, an in-depth look at its strengths and weaknesses allowed for reflection on whether the lessons learnt from this participatory governance model can be relevant for other settings. Overall, the power of stakeholder groups coming together has been impressively harnessed in the NHA process. The NHA has helped foster dialogue through understanding and respect for very differing takes on the same issue. The way in which different stakeholders discuss with each other in a real attempt at consensus thus represents a qualitatively improved policy dialogue. Nevertheless, the biggest challenge facing the NHA is ensuring a sustainable link to decision-making and the highest political circles. Modalities are needed to make NHA resolutions high priorities for the health sector. The NHA embodies many core features of a well-prepared deliberative process as defined in the literature (information provision, diverse views, opportunity to discuss freely) as well as key ingredients to enable the public to effectively participate (credibility, legitimacy and power). This offers important lessons for other countries for conducting similar processes. However, more research is necessary to understand how improvements in the deliberative process lead to concrete policy outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Rozenn Bichon
- Paris Institute of Political Science (Sciences Po), Paris, France
| | - Emma Ros
- Paris Institute of Political Science (Sciences Po), Paris, France
| | - Aurore Delobre
- Paris Institute of Political Science (Sciences Po), Paris, France
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Bentley C, Costa S, Burgess MM, Regier D, McTaggart-Cowan H, Peacock SJ. Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada. BMC Health Serv Res 2018; 18:339. [PMID: 29739463 PMCID: PMC5941483 DOI: 10.1186/s12913-018-3117-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens. METHODS In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens' input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software. RESULTS Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way. CONCLUSION The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.
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Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Sarah Costa
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, Southern Medical Program, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Dean Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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5
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Thomas R, Sims R, Degeling C, Street JM, Carter SM, Rychetnik L, Whitty JA, Wilson A, Ward P, Glasziou P. CJCheck Stage 1: development and testing of a checklist for reporting community juries - Delphi process and analysis of studies published in 1996-2015. Health Expect 2016; 20:626-637. [PMID: 27704684 PMCID: PMC5513001 DOI: 10.1111/hex.12493] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/25/2022] Open
Abstract
Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer‐reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. Design Using the literature and expertise from CJ researchers and policy advisors, a list of important CJ reporting items was suggested and further refined. We then reviewed published CJs within the health literature and used the checklist to assess the comprehensiveness of reporting. Results CJCheck was developed and examined reporting of CJ planning, juror information, procedures and scheduling. We screened 1711 studies and extracted data from 38. No studies fully reported the checklist items. The item most consistently reported was juror numbers (92%, 35/38), while least reported was the availability of expert presentations (5%, 2/38). Recruitment strategies were described in 66% of studies (25/38); however, the frequency and timing of deliberations was inadequately described (29%, 11/38). Conclusions Currently CJ publications in health and health policy literature are inadequately reported, hampering their use in policy making. We propose broadening the CJCheck by creating a reporting standards template in collaboration with international CJ researchers, policy advisors and consumer representatives to ensure standardized, systematic and transparent reporting.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jackie M Street
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Paul Ward
- Discipline of Public Health, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
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Timsit MO, Branchereau J, Thuret R, Kleinclauss F. [Renal transplantation in 2046: Future and perspectives]. Prog Urol 2016; 26:1132-1142. [PMID: 27665406 DOI: 10.1016/j.purol.2016.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report major findings that may build the future of kidney transplantation. MATERIAL AND METHODS Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database from 1960 to 2016 using the following keywords, in association, "bio-engineering; heterotransplantation; immunomodulation; kidney; regenerative medicine; xenotransplantation". Articles were selected according to methods, language of publication and relevance. A total of 5621 articles were identified including 2264 for xenotransplantation, 1058 for regenerative medicine and 2299 for immunomodulation; after careful selection, 86 publications were eligible for our review. RESULTS Despite genetic constructs, xenotransplantation faces the inevitable obstacle of species barrier. Uncertainty regarding xenograft acceptance by recipients as well as ethical considerations due to the debatable utilization of animal lives, are major limits for its future. Regenerative medicine and tridimensional bioprinting allow successful implantation of organs. Bioengineering, using decellularized tissue matrices or synthetic scaffold, seeded with pluripotent cells and assembled using bioreactors, provide exciting results but remain far for reconstituting renal complexity and vascular patency. Immune tolerance may be achieved through a tough initial T-cell depletion or a combined haplo-identical bone marrow transplant leading to lymphohematopoietic chimerism. CONCLUSION Current researches aim to increase the pool of organs available for transplantation (xenotransplants and bio-artificial kidneys) and to increase allograft survival through the induction of immune tolerance. Reported results suggest the onset of a thrilling new era for renal transplantation providing end-stage renal disease-patients with an improved survival and quality of life.
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Affiliation(s)
- M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
| | - J Branchereau
- Service d'urologie et transplantation, CHU de Nantes, 44000 Nantes, France
| | - R Thuret
- Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France
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Cheng M. Islet Xeno/transplantation and the risk of contagion: local responses from Canada and Australia to an emerging global technoscience. LIFE SCIENCES, SOCIETY AND POLICY 2015; 11:12. [PMID: 26497322 PMCID: PMC4617985 DOI: 10.1186/s40504-015-0030-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
This paper situates the public debate over the use of living animal organs and tissue for human therapies within the history of experimental islet transplantation. Specifically, the paper compares and contrasts the Canadian and Australian responses on xenotransplantation to consider what lessons can be learnt about the regulation of a complex and controversial biotechnology. Sobbrio and Jorqui described public engagement on xenotransplantation in these countries as 'important forms of experimental democracy.' While Canada experimented with a novel nation-wide public consultation, Australia sought public input within the context of a national inquiry. In both instances, the outcome was a temporary moratorium on all forms of clinical xenotransplantation comparable to the policies adopted in some European countries. In addition, the Australian xenotransplantation ban coincided with a temporary global ban on experimental islet allotransplantation in 2007. Through historical and comparative research, this paper investigates how public controversies over organ and tissue transplantation can inform our understanding of the mediation of interspeciality and the regulation of a highly contested technoscience. It offers an alternative perspective on the xenotransplantation controversy by exploring the ways in which coinciding moratoriums on islet allograft and xenograft challenge, complicate and confound our assumptions regarding the relationships between human and animal, between routine surgery and clinical experimentation, between biomedical science and social science, and between disease risks and material contagion.
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Affiliation(s)
- Myra Cheng
- University of Technology, Broadway, PO Box 123, Sydney, 2007 , NSW, Australia.
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8
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The use of citizens' juries in health policy decision-making: A systematic review. Soc Sci Med 2014; 109:1-9. [DOI: 10.1016/j.socscimed.2014.03.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/30/2014] [Accepted: 03/06/2014] [Indexed: 11/22/2022]
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9
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Assessing the impacts of citizen deliberations on the health technology process. Int J Technol Assess Health Care 2014; 29:282-9. [PMID: 23863188 DOI: 10.1017/s0266462313000299] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We assessed the impacts of a Citizens' Reference Panel on the deliberations of a provincial health technology advisory committee and its secretariat, which produce, recommendations for the use of health technologies in Ontario, Canada. METHODS A fourteen-member citizens' reference panel was convened five times between February 2009 and May 2010 to participate in informed, facilitated discussions to inform the assessment of individual technologies and provincial health technology assessment processes more generally. Qualitative data collection methods were used to document observed and perceived impacts of the citizens' panel on the health technology assessment (HTA) process. RESULTS Panel impacts were observed for all technologies reviewed, at two different stages in the HTA process, and represented macro- (raising awareness) and micro-level (informing recommendations) impacts. These impacts were shaped by periodic opportunities for direct and brokered exchange between the Panel and the expert advisory committee to clarify roles, foster accountability, and build trust. Our findings offer new insights about one of the main considerations in the design of deliberative participatory structures-how to maintain the independence of a citizens' panel while ensuring that their input is considered at key junctures in the HTA process. CONCLUSIONS Citizens' panels can exert various impacts on the HTA process. Ensuring these types of structures include opportunities for direct exchange between citizens and experts, to clarify roles, promote accountability, and build trust will facilitate their impacts in a variety of settings.
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Molster C, Potts A, McNamara B, Youngs L, Maxwell S, Dawkins H, O'Leary P. Informing Public Health Policy Through Deliberative Public Engagement: Perceived Impact on Participants and Citizen–Government Relations. Genet Test Mol Biomarkers 2013; 17:713-8. [DOI: 10.1089/gtmb.2013.0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Caron Molster
- Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
| | - Ayla Potts
- Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
| | - Beverley McNamara
- Faculty of Health Sciences, School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Leanne Youngs
- Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
| | - Susannah Maxwell
- Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
| | - Hugh Dawkins
- Department of Health, Office of Population Health Genomics, Perth, Western Australia, Australia
- Faculty of Health Sciences, Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Peter O'Leary
- Faculty of Health Sciences, Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
- School of Women's & Infants' Health, University of Western Australia, Perth, Western Australia, Australia
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11
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Frewer L, Kleter G, Brennan M, Coles D, Fischer A, Houdebine L, Mora C, Millar K, Salter B. Genetically modified animals from life-science, socio-economic and ethical perspectives: examining issues in an EU policy context. N Biotechnol 2013; 30:447-60. [DOI: 10.1016/j.nbt.2013.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 03/22/2013] [Accepted: 03/26/2013] [Indexed: 11/29/2022]
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Institutional policy learning and public consultation: the Canadian xenotransplantation experience. Soc Sci Med 2011; 73:655-62. [PMID: 21820782 DOI: 10.1016/j.socscimed.2011.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 05/27/2011] [Accepted: 06/12/2011] [Indexed: 11/23/2022]
Abstract
Attempts to evaluate public consultations, participatory technology assessment, and deliberative democracy have typically considered impacts on either policy or participants. The determination of impacts on policy institutions has been limited due to the challenges of tracing effects through the policy process, or penetrating bureaucratic walls. This paper presents findings from a retrospective study exploring the institutional lessons learned from a 2001 Canadian national public consultation on xenotransplantation. The consultation was conducted through an arm's-length process and involved the use of citizen juries in six regional sites. We conducted in-depth interviews of regulatory and policy actors who were engaged in early policy discussions and the consultation process. We reviewed evaluations of this process, both internal and external, which gave us richer insights into what institutional actors saw as the impacts of this consultative experience on their policy environment. Participants in our research identified a broader shift toward openness in policy culture which they linked specifically to the innovative consultation process employed for xenotransplantation. We argue that beyond input into policy decisions, a consultation may have an impact in terms of its contribution to overall shifts in institutional culture (related to institutional learning), such as an "opening" of technological decision processes to a broader range of actors, knowledge, and values.
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Schuppli CA, Weary DM. Attitudes towards the use of genetically modified animals in research. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2010; 19:686-697. [PMID: 21560543 DOI: 10.1177/0963662510362834] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Here we provide the first experimental evidence that public concerns about the use of animals in research are accentuated when genetically modified (GM) animals are used. Using an online survey, we probed participant views on two uses of pigs as research animals (to reduce agricultural pollution or to improve organ transplant success in humans) with and without GM. We surveyed 327 animal technicians, researchers, advocates, university students and others. In both scenarios and across demographics, support dropped off when the research required the use of GM pigs or GM corn. For example, 66% of participants supported using pigs to reduce phosphorus pollution, but this declined to 49% when the pigs were fed GM corn and to 20% when the research required the creation of a new GM line of pigs. Those involved in animal research were more consistently supportive compared to those who were not or those who were vegetarians.
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de Bruin WB, Güvenç U, Fischhoff B, Armstrong CM, Caruso D. Communicating about xenotransplantation: models and scenarios. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2009; 29:1105-1115. [PMID: 19508450 DOI: 10.1111/j.1539-6924.2009.01241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Xenotransplantation entails using organs from genetically modified animals as a way to solve the shortage of human organs for transplantation. As with other novel technologies, if xenotransplantation is to be judged fairly, proponents must explain its complex, uncertain, and unfamiliar risks and benefits. Xenotransplantation's risks include the possibility of a recombinant virus infecting human transplant recipients, potentially causing an epidemic of an unfamiliar disease. Using materials vetted by scientific experts, we communicated the variables and relationships determining this risk in three formally equivalent formats: (a) a graphic model, (b) scenarios structured by the graphic model, and (c) both the model and the scenarios. Participants were randomly assigned to receiving one set of materials. They rated them as equally clear and studied them equally long, suggesting similar ease of cognitive processing. Compared to participants receiving the scenarios, those who received the graphic model better identified causes and effects of the risk, and saw less risk of xenotransplantation. Participants who received both the model and the scenarios generally showed intermediate responses. The study demonstrates a general procedure for developing and evaluating formally equivalent graphic and scenario communications regarding highly uncertain risks. In this application to xenotransplantation, presenting a graphic representation improved people's understanding of the risk.
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Affiliation(s)
- Wändi Bruine de Bruin
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
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15
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Making policy decisions about population screening for breast cancer: the role of citizens' deliberation. Health Policy 2007; 85:314-20. [PMID: 17931738 DOI: 10.1016/j.healthpol.2007.08.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 08/13/2007] [Accepted: 08/31/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test a method of assessing whether a community of interest - when well informed - would be prepared to support or reject a public policy decision about cancer screening. In particular, whether the New Zealand government should offer free mammography screening to all women aged 40-49 years. METHODS Eleven women aged from 40 to 49 years, randomly selected from the electoral roll, agreed to participate in trial of a citizens' jury: a deliberative method of gathering the views of the public. Only selected aspects of the jury method were trialled. Participants met over a day and a half to hear evidence from expert witnesses with differing views and to deliberate the verdict. RESULTS All but one woman changed their minds during the jury process, and voted against government provision of mammography screening in this age group. The main reasons reported were the inaccuracy of the test and the potential for harm, and the lack of firm evidence of saving lives in this age group. CONCLUSIONS A deliberative 'citizens' jury' approach is a feasible way of eliciting a well informed, considered community view about screening or other population health initiatives. Pro-screening views of affected populations may change when individuals are given accurate information and enabled to deliberate about benefits and harms. This method could be used to determine how complex benefits and harms are weighed by affected populations, particularly where experts and advocacy groups disagree.
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Rock M, Mykhalovskiy E, Schlich T. People, other animals and health knowledges: towards a research agenda. Soc Sci Med 2007; 64:1970-6. [PMID: 17336436 DOI: 10.1016/j.socscimed.2007.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Indexed: 11/27/2022]
Abstract
By serving as experimental models for human disease, animals have been instrumental to constructing biomedical knowledge. On the other hand, animals themselves increasingly benefit from biomedical expertise and technologies, as patients in their own right. Healthy companion animals have recently come to be viewed explicitly as potential sources of human health, which contrasts with the potential for animals to injure people or transmit infectious disease. In studies of biomedical and other health knowledges, nevertheless, only the animal model role has been explored in any depth. In this review article, we sketch and discuss three research concerns that currently inform studies of biomedical knowledge: medicalization and biomedicalization; constructing biomedical knowledge; and a concern with heterogeneity. We conclude that a more comprehensive and nuanced account of contemporary societies will result from further consideration of the importance of animals for how people understand health.
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Affiliation(s)
- Melanie Rock
- Community Health Sciences, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alta., Canada T2N 1N4.
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Deschamps JY, Roux FA, Gouin E, Saï P. Reluctance of French patients with type 1 diabetes to undergo pig pancreatic islet xenotransplantation. Xenotransplantation 2005; 12:175-80. [PMID: 15807767 DOI: 10.1111/j.1399-3089.2005.00223.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Type 1 diabetes could possibly be treated by transplantation of pig pancreatic islets. In addition to medical difficulties and ethical problems, social hurdles may need to be overcome. We have evaluated the attitude of patients with type 1 diabetes to the xenotransplantation of pig pancreatic islets and to the potential risks associated with such treatment. METHODS A survey of 214 patients with type 1 diabetes was carried out in France based on a multiple-choice questionnaire. RESULTS At first, 52.0% of these patients indicated that they would agree to receive pig islet xenografts. The main sources of reluctance were the ''risk of disease transmission'' (55.5%) and ''risks not yet identified'' (48.7%). After they were told of the risk of cancer or infection associated with immunosuppression, 74.9% of the respondents chose to refuse the transplant, compared with 48.0% before they heard of such risks. A 68.1% would refuse the xenotransplant if it would not exempt them completely from being treated by insulin injections. Discontinuing insulin injections was the most important priority for diabetic patients (73.5%), rather than limitation of diabetes-related complications (52.5%) or increase in life expectancy (44.0%). After they were informed of all of the risks associated with the procedure, 70.5% of the respondents decided they would rather not take any risks, and said they would refuse pig islet transplantation. CONCLUSION When diabetic patients learned about potential infectious risks and other risks associated with immunosuppression, reluctance to undergo xenotransplantation gained in significance or even led to refusal of the procedure.
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Affiliation(s)
- Jack-Yves Deschamps
- Department of Cellular and Molecular Immuno-Endocrinology, ENVN, Atlanpole, La Chantrerie, BP 40706, 44307 Nantes Cedex 03, France.
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Terán-Escandón D, Terán-Ortiz L, Ormsby-Jenkins C, Evia-Viscarra ML, White DJG, Valdés-González-Salas R. Psychosocial aspects of xenotransplantation: Survey in adolescent recipients of porcine islet cells. Transplant Proc 2005; 37:521-4. [PMID: 15808697 DOI: 10.1016/j.transproceed.2005.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition. MATERIAL AND METHODS Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done. RESULTS Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy. CONCLUSIONS In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.
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Abstract
Although xenotransplantation could potentially benefit individuals with organ failure, this new technology is both controversial and potentially risky not only to recipients and their close contacts but also to society as a whole. The Canadian government wanted the public to have input into the decision of whether to pursue this new treatment. Therefore, Health Canada hired the Canadian Public Health Association to design and perform an arm's length public consultation; this program resulted in some high-profile negative recommendations. I offer an alternative analysis of the data collected during the consultation, which results in different conclusions.
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Affiliation(s)
- James R Wright
- Departments of Pathology, Surgery, and Biomedical Engineering, Dalhousie University Faculty of Medicine and IWK Health Centre, 5850 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada.
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Einsiedel EF. Commentary: On the position paper of the Ethics Committee of the International Xenotransplantation Association. Transplantation 2004; 78:1110-1. [PMID: 15502704 DOI: 10.1097/01.tp.0000142604.35960.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Position Paper of the Ethics Committee of the International Xenotransplantation Association has argued in favor of moving forward with xenotransplantation trials but only under highly controlled conditions, including consideration of ethical concerns. Although stressing the importance of ethics, this recommendation to proceed was ultimately based on a risk-benefit calculus. There are two areas that need to be addressed more fully: 1) the nature of the decision to be made; and 2) the nature and extent of participation by publics as part of this political process.
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Affiliation(s)
- Edna F Einsiedel
- Communication Studies Program, Faculty of Communication and Culture, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
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