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Jabour SM, Chander G, Riekert KA, Keruly JC, Herne K, Hutton H, Beach MC, Lau B, Moore RD, Monroe AK. The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS Behav 2021; 25:2963-2972. [PMID: 33559775 DOI: 10.1007/s10461-021-03175-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure: depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p < 0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.
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Chu D, Schuster T, Lessard D, Mate K, Engler K, Ma Y, Abulkhir A, Arora A, Long S, de Pokomandy A, Lacombe K, Rougier H, Cox J, Kronfli N, Hijal T, Kildea J, Routy JP, Asselah J, Lebouché B. Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study. J Pers Med 2021; 11:jpm11020134. [PMID: 33669439 PMCID: PMC7920437 DOI: 10.3390/jpm11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal's potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.
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Affiliation(s)
- Dominic Chu
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Kedar Mate
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
| | - Kim Engler
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Yuanchao Ma
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Ayoub Abulkhir
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Anish Arora
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Karine Lacombe
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
| | - Hayette Rougier
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
- IMEA, Institut de Médecine et d’Epidémiologie Appliquée, F75018 Paris, France
| | - Joseph Cox
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Nadine Kronfli
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - John Kildea
- Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada;
| | - Jean-Pierre Routy
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Jamil Asselah
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Correspondence: ; Tel.: +1-514-843-2090
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Lessard D, Engler K, Vicente S, Bilodeau M, Lebouché B. Challenges of Patient Engagement in an HIV Clinical Research Program: A Qualitative Analysis of Stakeholder Accounts. J Patient Exp 2020; 7:925-930. [PMID: 33457522 PMCID: PMC7786743 DOI: 10.1177/2374373520975728] [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] [Indexed: 01/27/2023] Open
Abstract
Patient engagement (PE) promotes collaboration between stakeholders (researchers, patients, clinicians, etc). It often faces challenges due to tensions between its ethical/political and scientific underpinnings. This article explores how stakeholders applied the guiding principles of a PE project (“co-build,” “support and mutual respect,” and “inclusiveness”) for an HIV clinical research program initiated in January 2016. Three researchers/clinicians, a PE agent, and 2 patients held 3 meetings (June-October 2018) to discuss challenges faced and how these impacted their approach to PE. Regular stakeholder discussions about PE in clinical research could be documented and help guide PE to better meet stakeholder needs.
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Affiliation(s)
- David Lessard
- Chronic and Viral Illness Service (CVIS), McGill University Health Centre (MUHC), Montreal, Canada.,Centre for Health Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada.,Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada
| | - Kim Engler
- Chronic and Viral Illness Service (CVIS), McGill University Health Centre (MUHC), Montreal, Canada.,Centre for Health Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada.,Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada
| | - Serge Vicente
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada.,Department of Mathematics and Statistics, Université de Montréal, Montreal, Canada
| | - Martin Bilodeau
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada.,Ontario AIDS Network, Positive Leadership Development Institute (PLDI), Toronto, Canada
| | - Bertrand Lebouché
- Chronic and Viral Illness Service (CVIS), McGill University Health Centre (MUHC), Montreal, Canada.,Centre for Health Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada.,Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
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Engler K, Ahmed S, Lessard D, Vicente S, Lebouché B. Assessing the Content Validity of a New Patient-Reported Measure of Barriers to Antiretroviral Therapy Adherence for Electronic Administration in Routine HIV Care: Proposal for a Web-Based Delphi Study. JMIR Res Protoc 2019; 8:e12836. [PMID: 31376275 PMCID: PMC6696859 DOI: 10.2196/12836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/24/2022] Open
Abstract
Background Adherence to lifesaving antiretroviral therapy (ART) for HIV infection remains a challenge for many patients. Routine screening for barriers to ART adherence could help make HIV care more patient-centered and prevent virologic rebound or failure. Our team is currently developing a new HIV-specific patient-reported outcome measure (PROM) of these barriers for use in Canada and France along with a digital app for its electronic administration. In our previous work, we developed the PROM’s multidimensional conceptual framework and generated 100 English items, which have been translated to French. Objective This study aims to use a Web-based Delphi to help validate and select the content of this new HIV-specific PROM, based on the perspective of anglophone and francophone patients and providers in Canada and France. Here, we present the proposal for this Delphi. Methods This modified Delphi will involve a diverse panel of patients (n=32) and providers (n=52) recruited especially from the 9 sites of the PROM development study (site locations in Canada: Montreal, Toronto, Vancouver; in France: Paris, Nantes, Clermont-Ferrand, Saint-Martin, Cayenne). Overall, 2 rounds of Web-based questionnaires will be conducted. The threshold for consensus is set at 60% and will determine which items are carried forward to the second round. Per item, 3 aspects will be rated: importance as a barrier to ART adherence, relevance for HIV care, and clarity. In both rounds, space will be available for free text comments. Overall comprehensiveness will be assessed in the second round. Results This study has undergone a methodological review by experts in patient-oriented research. It has received approval from a research ethics board of the McGill University Health Centre. It is financially supported, in part, by the Canadian Institutes of Health Research’s Strategy for Patient-Oriented Research-Quebec Support Unit (M006). As of May 21, 2019, 15 people living with HIV and 25 providers completed the first round of the Delphi (24 from Canada and 16 from France). Conclusions To our knowledge, this is the first Delphi to seek consensus on the most relevant and clinically actionable barriers to ART adherence, collecting opinions on an extensive list of barriers. Drawing on a relatively large and diverse panel of HIV patients and providers, it essentially engages key stakeholders in decision making about the PROM’s final content, helping to ensure its utility and adoption. International Registered Report Identifier (IRRID) PRR1-10.2196/12836
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Affiliation(s)
- Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Sara Ahmed
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada
| | - David Lessard
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Serge Vicente
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Chronic Viral Illness Service, Royal Victoria Hospital, Montreal, QC, Canada
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Lessard D, Engler K, Toupin I, Routy J, Lebouché B. Evaluation of a project to engage patients in the development of a patient-reported measure for HIV care (the I-Score Study). Health Expect 2019; 22:209-225. [PMID: 30375111 PMCID: PMC6433311 DOI: 10.1111/hex.12845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patient engagement (PE), patients' meaningful involvement in research through partnerships and sensitivity to their expertise, is receiving attention. However, PE initiatives are poorly reported and little is known about patients' perspective on PE. OBJECTIVE To document and evaluate the first phase (22 months) of a PE Project for the I-Score Study which is developing a patient-reported measure of HIV treatment adherence barriers, we describe the nature of PE conducted, determine the level of PE achieved and present its impacts from the engaged patients' perspective. SETTING AND PARTICIPANTS A Montreal-based committee of ten people with HIV was recruited from community and clinical settings and participated in: I-Score study decision making, knowledge dissemination, research on the experience of people with HIV and the PE project's evaluation. METHODS The evaluation followed a convergent parallel mixed-methods design. Data collection included participant observation, a satisfaction survey and meeting minutes/transcriptions. Analysis entailed reporting PE activities, generating descriptive statistics and thematically analysing qualitative material. RESULTS PE consisted of twelve meetings, including two focus groups (needs assessment), in addition to four knowledge dissemination activities. PE levels showed an increase: the first four regular meetings entailed information/consultation, while subsequent meetings reached implication/collaboration. Regarding impacts, patients indicated high and stable satisfaction rates (M = 4.4/5; SD = 0.76). Furthermore, thematic analysis identified "positive interactions," "co-learning," "self-determination," and "the collective management of confidentiality" as important PE impacts for engaged patients. CONCLUSION This PE Project evaluation highlighted growing engagement levels, high satisfaction rates and the importance of a patient-centric approach to PE.
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Affiliation(s)
- David Lessard
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Research Institute of the McGill University Health Centre (MUHC)MontrealQuebecCanada
- Royal Victoria Hospital, Chronic and Viral Illness Service (MUHC)MontrealQuebecCanada
- SPOR Mentorship Chair in Innovative Clinical Trials of the CIHRMontrealQuebecCanada
| | - Kim Engler
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Research Institute of the McGill University Health Centre (MUHC)MontrealQuebecCanada
- Royal Victoria Hospital, Chronic and Viral Illness Service (MUHC)MontrealQuebecCanada
- SPOR Mentorship Chair in Innovative Clinical Trials of the CIHRMontrealQuebecCanada
| | - Isabelle Toupin
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Research Institute of the McGill University Health Centre (MUHC)MontrealQuebecCanada
- Royal Victoria Hospital, Chronic and Viral Illness Service (MUHC)MontrealQuebecCanada
- SPOR Mentorship Chair in Innovative Clinical Trials of the CIHRMontrealQuebecCanada
| | | | - Jean‐Pierre Routy
- Research Institute of the McGill University Health Centre (MUHC)MontrealQuebecCanada
- Royal Victoria Hospital, Chronic and Viral Illness Service (MUHC)MontrealQuebecCanada
| | - Bertrand Lebouché
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Research Institute of the McGill University Health Centre (MUHC)MontrealQuebecCanada
- Royal Victoria Hospital, Chronic and Viral Illness Service (MUHC)MontrealQuebecCanada
- SPOR Mentorship Chair in Innovative Clinical Trials of the CIHRMontrealQuebecCanada
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Engler K, Lènàrt A, Lessard D, Toupin I, Lebouché B. Barriers to antiretroviral therapy adherence in developed countries: a qualitative synthesis to develop a conceptual framework for a new patient-reported outcome measure. AIDS Care 2018; 30:17-28. [PMID: 29719990 DOI: 10.1080/09540121.2018.1469725] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Suboptimal adherence to antiretroviral therapy (ART) remains common. Patient-centered tools are needed to comprehensively assess adherence barriers in HIV clinical practice. Thus, we conducted a research synthesis to produce a conceptual framework for a new patient-reported outcome measure (PRO) for use in routine HIV care in Canada and France. A PRO's conceptual framework graphically represents the concepts to be measured and the potential relationships between them. Towards ensuring the framework's relevance to the target populations' concerns, qualitative studies with HIV-positive adults on barriers to ART adherence in developed countries were synthesized with thematic analysis, attending to the cross-study prevalence and interrelationships of barrier themes. In March 2016, searches within Medline, PsychINFO, and Embase produced 5,284 records. Two reviewers determined the final sample (n = 41). Analysis generated three levels of ART adherence barrier themes. Twenty Level 2 themes and their component subthemes (Level 3) were organized into 6 higher-order themes (Level 1): Cognitive and emotional aspects (100% of studies contributing content -prevalence), Lifestyle factors (95%), Social and material context (95%), Characteristics of ART (90%), Health experience and state (73%), and Healthcare services and system (66%). As to interrelationships, study authors articulated relationships between all higher-order themes (Level 3). Linkages between Level 2 barrier themes showed great variability, from 21% to 95%. Overall, this synthesis contributes an exceptionally detailed conceptual framework and report of ART adherence barriers, applicable to a wide range of PLHIV. It suggests that a key to understanding many barriers is through their interconnections. It also identifies gaps in barrier research. Concerning the new PRO's development, comprehensiveness will need to be weighed against other concerns (e.g., respondent burden) and the provision of barrier-specific guidance for clinically addressing its scores seems essential.
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Affiliation(s)
- Kim Engler
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Andras Lènàrt
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - David Lessard
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Isabelle Toupin
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Bertrand Lebouché
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada.,d Chronic Viral Illness Service , Royal Victoria Hospital, MUHC , Montreal , QC , Canada
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Toupin I, Engler K, Lessard D, Wong L, Lènàrt A, Spire B, Raffi F, Lebouché B. Developing a patient-reported outcome measure for HIV care on perceived barriers to antiretroviral adherence: assessing the needs of HIV clinicians through qualitative analysis. Qual Life Res 2017; 27:379-388. [PMID: 29027607 DOI: 10.1007/s11136-017-1711-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To identify HIV clinicians' needs for the clinical use of a new patient-reported outcome measure (PRO) on barriers to antiretroviral therapy (ART) adherence. METHODS In 2015, five focus groups with 31 clinicians from France were transcribed, coded with Atlas.ti, and submitted to a typological analysis. RESULTS The analysis identified seven patient profiles, each tied to distinct barriers to adherence and to specific needs for the PRO's content, data collection and transmission. Clinicians preferred, for the patient who is: (1) 'passive,' that the PRO collect information on ART knowledge, to ensure that the prescription's instructions are being respected; (2) 'misleading,' that it be able to detect adherence to ART and socially desirable responses; (3) 'stoic,' that questions challenge the patient to recognize treatment-specific side effects; (4) 'hedonistic,' that the PRO contains content on lifestyle and risk-taking; (5) 'obsessive,' that the PRO captures quality of life and stressful life events; (6) 'overburdened,' that the PRO provides information on the person's home environment, socioeconomic status and cultural constraints. For all or most patient profiles, the clinicians wished that the PRO be completed, minimally, prior to the medical consultation and to receive alerts, under varying conditions, when problematic scores were detected. Depending on the profile, there was preference for the inclusion of open-ended questions and transmission of cross-sectional, periodic or longitudinal PRO data. CONCLUSION Overall, this study's findings suggest that to support the clinical management of ART adherence, our PRO must meet the needs of a wide variety of patients and must perform multiple functions.
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Affiliation(s)
- Isabelle Toupin
- Department of Family Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul de Maisonneuve, 3C.35, Montreal, QC, H4A 3S5, Canada.
- Royal Victoria Hospital, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.
- Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research), Montreal, Canada.
| | - Kim Engler
- Department of Family Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul de Maisonneuve, 3C.35, Montreal, QC, H4A 3S5, Canada
- Royal Victoria Hospital, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research), Montreal, Canada
| | - David Lessard
- Department of Family Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul de Maisonneuve, 3C.35, Montreal, QC, H4A 3S5, Canada
- Royal Victoria Hospital, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research), Montreal, Canada
| | - Leo Wong
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul de Maisonneuve, 3C.35, Montreal, QC, H4A 3S5, Canada
- Royal Victoria Hospital, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Andràs Lènàrt
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Bruno Spire
- SESSTIM, Université Aix-Marseille, Marseille, France
| | - François Raffi
- Department of Infectious Diseases, CHU de Nantes and CIC 1413, INSERM, Nantes, France
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul de Maisonneuve, 3C.35, Montreal, QC, H4A 3S5, Canada
- Royal Victoria Hospital, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research), Montreal, Canada
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Toupin I, Engler K, Lessard D, Wong L, Lènàrt A, Raffi F, Spire B, Lebouché B. Patient profiles as organizing HIV clinicians' ART adherence management: a qualitative analysis. AIDS Care 2017; 30:207-210. [PMID: 28764563 DOI: 10.1080/09540121.2017.1360995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The effectiveness of antiretroviral therapy (ART) depends on optimal clinical management and patient adherence. Little is known about patient characteristics that clinicians consider in the management of ART adherence. Exploring this issue, five focus groups were conducted with 31 HIV-clinicians from across France. A qualitative typological analysis suggests that clinician management of patient adherence is based on characteristics that coalesce into seven patient profiles. For the "passive" patient, described as taking ART exactly as prescribed without questioning their doctor's expertise, a directive and simple management style was preferred. The "misleading" patient is characterized as concerned with social desirability and as reporting no adherence difficulties for fear of displeasing their doctor. If clinical outcomes are suboptimal, the clinicians' strategy is to remind them of the importance of open patient-clinician communication. The "stoic" patient is described as requesting and adequately taking the most potent ART available. Here, clinicians emphasize assessment of side effects, which the patient may minimize. The "hedonistic" patient's festive lifestyle and sexual risk-taking are seen as compromising adherence; with them, clinicians stress the patient's responsibility for their own health and that of their sexual partners. The "obsessive" patient is portrayed as having an irrational fear of ART failure and an inability to distinguish illusory from genuine adherence barriers. With this patient, clinicians seek to identify the latter. The "overburdened" patient is recognized as coping with life priorities that interfere with adherence and, with them, a forgiving ART is favored. The "underprivileged" patient is presented as having limited education, income and housing. In this case, clinicians seek to improve the patient's living conditions and access to care. These results shed light on HIV clinicians' ART adherence management. The value of these profiles for HIV care and patients should be investigated.
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Affiliation(s)
- Isabelle Toupin
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - Kim Engler
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - David Lessard
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
| | - Leo Wong
- b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada
| | - Andràs Lènàrt
- a Department of Family Medicine , McGill University , Montreal , Canada
| | - Francois Raffi
- e Department of Infectious Diseases , CHU de Nantes and CIC 1413, INSERM , Nantes , France
| | - Bruno Spire
- f SESSTIM , Université Aix-Marseille , Marseille , France
| | - Bertrand Lebouché
- a Department of Family Medicine , McGill University , Montreal , Canada.,b Research Institute , McGill University Health Centre , Montreal , Canada.,c Royal Victoria Hospital, Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.,d Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials (Canadian Institutes of Health Research) , Montreal , Canada
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