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Archambault PM, Rosychuk RJ, Audet M, Hau JP, Graves L, Décary S, Perry JJ, Brooks SC, Morrison LJ, Daoust R, Yeom DS, Wiemer H, Fok PT, McRae AD, Chandra K, Kho ME, Stacey D, Vissandjée B, Menear M, Mercier E, Vaillancourt S, Aziz S, Zakaria D, Davis P, Dainty KN, Paquette JS, Leeies M, Goulding S, Berger Pelletier E, Hohl CM. Post-COVID-19 condition symptoms among emergency department patients tested for SARS-CoV-2 infection. Nat Commun 2024; 15:8449. [PMID: 39349926 PMCID: PMC11442466 DOI: 10.1038/s41467-024-52404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 09/05/2024] [Indexed: 10/04/2024] Open
Abstract
Symptoms of the Post-COVID-19 Condition are often non-specific making it a challenge to distinguish them from symptoms due to other medical conditions. In this study, we compare the proportion of emergency department patients who developed symptoms consistent with the World Health Organization's Post-COVID-19 Condition clinical case definition between those who tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 infection and time-matched patients who tested negative. Our results show that over one-third of emergency department patients with a proven acute infection meet Post-COVID-19 Condition criteria 3 months post-index visit. However, one in five test-negative patients who claim never having been infected also report symptoms consistent with Post-COVID-19 Condition highlighting the lack of specificity of the clinical case definition. Testing for SARS-CoV-2 during the acute phase of a suspected infection should continue until specific biomarkers of Post-COVID-19 Condition become available for diagnosis and treatment.
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Affiliation(s)
- Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Martyne Audet
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Lorraine Graves
- Patient Engagement Committee, Canadian COVID-19 Emergency Department Rapid Response Network, The University of British Columbia, Vancouver, BC, Canada
| | - Simon Décary
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Laurie J Morrison
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raoul Daoust
- Département de médecine de famille et de médecine d'urgence, Université de Montréal, Montréal, QC, Canada
- Département de médecine d'urgence, Hôpital du Sacré-Cœur-de-Montréal, Montréal, QC, Canada
| | - David Seonguk Yeom
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hana Wiemer
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Eric Mercier
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d'urgence, Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | - Samuel Vaillancourt
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Samina Aziz
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Dianne Zakaria
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Phil Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katie N Dainty
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Susie Goulding
- Patient Engagement Committee, Canadian COVID-19 Emergency Department Rapid Response Network, The University of British Columbia, Vancouver, BC, Canada
- COVID Long-Haulers Support Group Canada, Oakville, ON, Canada
| | - Elyse Berger Pelletier
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
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Termoz A, Subtil F, Drouin P, Marchal M, Verroul M, Langlois C, Bravant E, Jacquin L, Clément B, Viglino D, Roux-Boniface D, Verbois F, Demarquet M, Dubucs X, Douillet D, Tazarourte K, Schott-Pethelaz AM, Haesebaert J, Douplat M. Evaluating the impact of a standardised intervention for announcing decisions of withholding and withdrawing life-sustaining treatments on the stress of relatives in emergency departments (DISCUSS): protocol for a stepped-wedge randomised controlled trial. BMJ Open 2024; 14:e087444. [PMID: 39237283 PMCID: PMC11381699 DOI: 10.1136/bmjopen-2024-087444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION The decisions of withholding or withdrawing life-sustaining treatments are difficult to make in the context of emergency departments (EDs) because most patients are unable to communicate. Relatives are thus asked to participate in the decision-making process, although they are unprepared to face such situations. We therefore aimed to develop a standardised intervention for announcing decisions of withholding or withdrawing life-sustaining treatments in EDs and assess the efficacy of the intervention on the stress of relatives. METHODS AND ANALYSIS The DISCUSS trial is a multicentre stepped-wedge cluster randomised study and will be conducted at nine EDs in France. A standardised intervention based on human simulation will be codesigned with partner families and implemented at three levels: the relatives, the healthcare professionals (HCP) and the EDs. The intervention will be compared with a control based on treatment as usual. A total of 538 families are planned to be included: 269 in the intervention group and 269 in the control group. The primary endpoint will be the symptoms of post-traumatic stress disorder (PTSD) at 90 days. The secondary endpoints will be symptoms of PTSD at 7 and 30 days, diagnosis of PTSD at 90 days and anxiety and depression scores at 7, 30 and 90 days. Satisfaction regarding the training, the assertiveness in communication and real-life stress of HCPs will be measured at 90 days. ETHICS AND DISSEMINATION This study was approved by the ethics committee Est III from Nancy and the French national data protection authority. All relatives and HCPs will be informed regarding the study objectives and data confidentiality. Written informed consent will be obtained from participants, as required by French law for this study type. The results from this study will be disseminated at conferences and in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT06071078.
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Affiliation(s)
- Anne Termoz
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fabien Subtil
- Pôle Santé Publique, Service de Biostatistique et Bio-informatique, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Pauline Drouin
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Mathilde Marchal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Manon Verroul
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Carole Langlois
- Pôle Santé Publique, Service de Biostatistique et Bio-informatique, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Estelle Bravant
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Laurent Jacquin
- Hôpital Edouard Herriot, Service d'Accueil des Urgences, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Bénédicte Clément
- Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Damien Viglino
- Hôpital Nord, Service d'Accueil des Urgences, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Daniel Roux-Boniface
- Hôpital Gabriel Montpied, Service d'Accueil des Urgences, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Frédéric Verbois
- Centre Hospitalier Nord Ouest, Service d'Accueil des Urgences, Hopital de Villefranche-sur-Saone, Villefranche-sur-Saone, Auvergne-Rhône-Alpes, France
| | - Marine Demarquet
- Centre Hospitalier Fleyriat, Service d'Accueil des Urgences, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rhône-Alpes, France
| | - Xavier Dubucs
- Hôpital Larrey, Service d'Accueil des Urgences, Centre Hospitalier Universitaire de Toulouse, Toulouse, Occitanie, France
| | - Delphine Douillet
- Hôpital Larrey, Service d'Accueil des Urgences, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Hôpital Edouard Herriot, Service d'Accueil des Urgences, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Anne-Marie Schott-Pethelaz
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1-Domaine de Rockefeller, Lyon, Rhône-Alpes, France
- Hôpital Lyon Sud, Service d'Accueil des Urgences, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
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Patient Engagement in Health Research: Perspectives from Patient Participants. Curr Oncol 2023; 30:2770-2780. [PMID: 36975423 PMCID: PMC10047022 DOI: 10.3390/curroncol30030210] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Background and purpose: Over the past decade, patient engagement (PE) has emerged as an important way to help improve the relevance, quality, and impact of health research. However, there is limited consensus on how best to meaningfully engage patients in the research process. The goal of this article is to share our experiences and insights as members of a Patient Advisory Committee (PAC) on a large, multidisciplinary cancer research study that has spanned six years. We hope by sharing our reflections of the PAC experiences, we can highlight successes, challenges, and lessons learned to help guide PE in future health research. To the best of our knowledge, few publications describing PE experiences in health research teams have been written by patients, survivors, or family caregivers themselves. Methods: A qualitative approach was used to gather reflections from members of the Patient Advisory Committee regarding their experiences in participating in a research study over six years. Each member completed an online survey and engaged in a group discussion based on the emergent themes from the survey responses. Results: Our reflections about experiences as a PAC on a large, pan-Canadian research study include three overarching topics (1) what worked well; (2) areas for improvement; and (3) reflections on our overall contribution and impact. Overall, we found the experience positive and experienced personal satisfaction but there were areas where future improvements could be made. These areas include earlier engagement and training in the research process, more frequent communication between the patient committee and the research team, and on-going monitoring regarding the nature of the patient engagement. Conclusions: Engaging individuals who have experienced the types of events which are the focus of a research study can contribute to the overall relevance of the project. However, intentional efforts are necessary to ensure satisfactory involvement.
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Bertorello D, Brichetto G, Folkvord F, Theben A, Zaratin P. A Systematic Review of Patient Engagement Experiences in Brain Disorders. Patient Relat Outcome Meas 2022; 13:259-272. [DOI: 10.2147/prom.s256396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
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Chen KCJ, Thiruganasambandamoorthy V, Campbell SG, Upadhye S, Dowling S, Chartier LB. Choosing Wisely Canada: scratching the 7-year itch. CAN J EMERG MED 2022; 24:569-573. [PMID: 35819640 PMCID: PMC9273920 DOI: 10.1007/s43678-022-00349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/15/2022] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Samuel G Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Shawn Dowling
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucas B Chartier
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Chartash D, Sharifi M, Emerson B, Frank R, Schoenfeld EM, Tanner J, Brandt C, Taylor RA. Documentation of Shared Decisionmaking in the Emergency Department. Ann Emerg Med 2021; 78:637-649. [PMID: 34340873 DOI: 10.1016/j.annemergmed.2021.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE While patient-centered communication and shared decisionmaking are increasingly recognized as vital aspects of clinical practice, little is known about their characteristics in real-world emergency department (ED) settings. We constructed a natural language processing tool to identify patient-centered communication as documented in ED notes and to describe visit-level, site-level, and temporal patterns within a large health system. METHODS This was a 2-part study involving (1) the development and validation of an natural language processing tool using regular expressions to identify shared decisionmaking and (2) a retrospective analysis using mixed effects logistic regression and trend analysis of shared decisionmaking and general patient discussion using the natural language processing tool to assess ED physician and advanced practice provider notes from 2013 to 2020. RESULTS Compared to chart review of 600 ED notes, the accuracy rates of the natural language processing tool for identification of shared decisionmaking and general patient discussion were 96.7% (95% CI 94.9% to 97.9%) and 88.9% (95% confidence interval [CI] 86.1% to 91.3%), respectively. The natural language processing tool identified shared decisionmaking in 58,246 (2.2%) and general patient discussion in 590,933 (22%) notes. From 2013 to 2020, natural language processing-detected shared decisionmaking increased 300% and general patient discussion increased 50%. We observed higher odds of shared decisionmaking documentation among physicians versus advanced practice providers (odds ratio [OR] 1.14, 95% CI 1.07 to 1.23) and among female versus male patients (OR 1.13, 95% CI 1.11 to 1.15). Black patients had lower odds of shared decisionmaking (OR 0.8, 95% CI 0.84 to 0.88) compared with White patients. Shared decisionmaking and general patient discussion were also associated with higher levels of triage and commercial insurance status. CONCLUSION In this study, we developed and validated an natural language processing tool using regular expressions to extract shared decisionmaking from ED notes and found multiple potential factors contributing to variation, including social, demographic, temporal, and presentation characteristics.
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Affiliation(s)
- David Chartash
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
| | - Mona Sharifi
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Beth Emerson
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Robert Frank
- Department of Linguistics, Yale University, New Haven, CT
| | - Elizabeth M Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School - Baystate Institute for Healthcare Delivery and Population Science, Springfield, MS
| | - Jason Tanner
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Cynthia Brandt
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Richard A Taylor
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
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RAFF-3 Trial: A Stepped-Wedge Cluster Randomized Trial to Improve Care of Acute Atrial Fibrillation and Flutter in the Emergency Department. Can J Cardiol 2021; 37:1569-1577. [PMID: 34217808 DOI: 10.1016/j.cjca.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We sought to improve care of patients with acute atrial fibrillation (AF) and flutter (AFL) in the emergency department (ED) by implementing the CAEP AAFF Best Practice Checklist. METHODS We conducted a stepped-wedge cluster randomized trial at 11 large community and academic hospital EDs, in five Canadian provinces and enrolled consecutive AF/AFL patients. The study intervention was the introduction of the CAEP Checklist using a knowledge translation-implementation approach that included behavior change techniques and organization/system level strategies. The primary outcome was length of stay in ED and secondary outcomes were discharge home, use of rhythm control, adverse events, and 30-day status. Analysis used mixed effects regression adjusting for covariates. RESULTS Patient visits in the control (N=314) and intervention (N=404) periods were similar with mean age 62.9, 54% male, 71% onset <12 hours, and 86% atrial fibrillation, 14% atrial flutter. We observed a reduction in length of stay of 20.9% (95% CI 5.5 to 33.8%, P=0.01), an increase in use of rhythm control (adjusted odds ratio (OR 4.5, 1.8-11.6; P=0.002), and decrease in use of rate control medications (OR 0.5, 0.2 to 0.9; P=0.02). There was no change in adverse events and no strokes or deaths by 30 days. CONCLUSIONS The RAFF-3 Trial led to optimized care of AF/AFL patients with decreased ED lengths of stay, increased ED rhythm control by drug or electricity, and no increase in adverse events. Early cardioversion allows AF/AFL patients to quickly resume normal activities. CLINICALTRIALS. GOV IDENTIFIER NCT03627143.
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Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
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Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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10
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Michaud S, Needham J, Sundquist S, Johnson D, Hanna S, Hosseinzadeh S, Bartekian V, Steele P, Benchimol S, Ross N, Stein BD. Patient and Patient Group Engagement in Cancer Clinical Trials: A Stakeholder Charter. Curr Oncol 2021; 28:1447-1458. [PMID: 33917947 PMCID: PMC8167642 DOI: 10.3390/curroncol28020137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background-to guide the implementation of patient centricity and engagement in cancer clinical trials (CTs) and to operationalize the Canadianized version of the Clinical Trials Transformation Initiative (C-CTTI) model, the development of a charter was identified by cancer CT stakeholders. Methods-the Canadian Cancer Trial Stakeholder Charter (the Charter) was initiated by Colorectal Cancer Canada (CCC) and developed via the-1-formation of an inclusive working group (WG) that drafted the document using recommendations collected during the development of the C-CTTI model; 2-socialization of the draft Charter to solicit feedback from cancer CT stakeholders, including those who attended the 2019 CCC Conference; and 3-incorporation of stakeholders' feedback and finalization of the Charter by the WG. Results-the Charter was built around five guiding principles-1-patient centricity; 2-commitment to education and training; 3-collaboration as equal and independent partners in research; 4-transparency and accountability; and 5-high standards in data collection integrity and honesty. These principles led to the Charter's five tenets, which stipulate stakeholder commitments, aiming to make CTs accessible to all patients, improve the design and implementation of CTs to benefit patients, expand recruitment and retention of patients in CTs, and further advance cancer research and treatment. Conclusions-the Charter is intended to integrate the patient voice into the Canadian cancer CT continuum. The next phases of the C-CTTI model include the adoption and implementation of the Charter, the establishment of a patient group training program, and the development of real-world evidence/real-world data methodologies.
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Affiliation(s)
| | - Judy Needham
- Canadian Cancer Trials Group, Kingston, ON K7L 3N6, Canada;
| | - Stephen Sundquist
- Canadian Cancer Clinical Trials Network (3CTN), Toronto, ON M5G 0A3, Canada;
| | - Dominique Johnson
- McPeak-Sirois Group for Clinical Research in Breast Cancer, Montreal, QC H2Y 2H2, Canada;
| | - Sabrina Hanna
- The Cancer Collaborative, Montreal, QC H7W 0C3, Canada;
| | | | | | - Patricia Steele
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | - Sarita Benchimol
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | | | - Barry D. Stein
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
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11
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Rasiah J, Manafò E, Krawec K, Nielssen I, Amirav I, Macphail EC, Lavigne LA, Asis S. Albertans for Health Research Network: Form, Fit, and Function. J Patient Exp 2021; 7:973-977. [PMID: 33457531 PMCID: PMC7786747 DOI: 10.1177/2374373520925245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The patient engagement (PE) platform staff of Alberta Strategy for Patient Oriented Research Support for People and Patient Oriented Research Trials Unit developed a patient-powered PE network called Albertans for Health Research Network (AB4HR); an enhanced tool to better connect patient partners and researchers online. AB4HR was developed in response to an identified need—a user-friendly online forum for both patient partners and researchers to access, so that they can better work together, as partners, in health research. We codesigned AB4HR and identified ways to improve the form, fit, and function of an existing registry through discussion groups with patient partners and researchers. We found 3 main themes derived from the perspective shared by patient partners and researchers. Patient partners and researchers agreed that the existing registry provides a forum to connect with one another in an easy, low-barrier way. However, there were opportunities for improvement with AB4HR, including possibilities for greater interaction between patient partners and researchers to promote more collaborative partnerships.
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Affiliation(s)
- Jananee Rasiah
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Alberta, Canada.,Faculty of Health Disciplines, Athabasca University, Alberta, Canada.,Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Elizabeth Manafò
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Alberta, Canada.,Faculty of Health Disciplines, Athabasca University, Alberta, Canada
| | - Kiara Krawec
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Alberta, Canada.,Faculty of Health Disciplines, Athabasca University, Alberta, Canada
| | - Ingrid Nielssen
- Faculty of Health Disciplines, Athabasca University, Alberta, Canada.,Department of Pediatrics, University of Alberta, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Israel Amirav
- Department of Pediatrics, University of Alberta, Alberta, Canada
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12
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Drebit S, Eggers K, Archibald C, Abu-Laban R, Ho K, Khazei A, Lindstrom R, Marsden J, Martin E, Christenson J. Evaluation of Patient Engagement in a Clinical Emergency Care Network: Findings From the BC Emergency Medicine Network. J Patient Exp 2021; 7:937-940. [PMID: 33457524 PMCID: PMC7786762 DOI: 10.1177/2374373520925721] [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] [Indexed: 11/16/2022] Open
Abstract
The British Columbia Emergency Medicine Network (EM Network) has collaborated with patient partners to utilize their experiential knowledge to inform planning and implementation. Patient partners participated in several EM Network committees and initiatives. This study evaluated how patient partners and other leaders in the EM Network perceived patient engagement efforts 1 year after launch. The Public and Patient Engagement Evaluation Tool V2.0 found that there was an appropriate level of patient engagement at this early stage, an opportunity to attract more patient partners as the EM Network grows, and a need to ensure adequate resources to support more activities.
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Affiliation(s)
- Sharla Drebit
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Kim Eggers
- Patient Voices Network, Vancouver, British Columbia, Canada
| | - Chantel Archibald
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Riyad Abu-Laban
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Afshin Khazei
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Ronald Lindstrom
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Julian Marsden
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Ed Martin
- Patient Voices Network, Vancouver, British Columbia, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
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13
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Adapting two American Decision Aids for Mild Traumatic Brain Injury to the Canadian Context Using the Nominal Group Technique. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:729-743. [PMID: 33078377 DOI: 10.1007/s40271-020-00459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans. OBJECTIVE The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head CT use for adult and paediatric mild traumatic brain injury to the Canadian context. METHODS We invited 21 Canadian stakeholders and the two authors of the American decision aids to a Nominal Group Technique consensus meeting to generate suggestions for adapting the decision aids. This method encourages idea generation and sharing between team members. Each idea was discussed and then prioritised using a voting system. We collected data using videotaping, writing material and online collaborative writing tools. The modifications proposed were analysed using a qualitative thematic content analysis. RESULTS Twenty-one participants took part in the meeting, including researchers and clinician researchers (n = 9; 43%), patient partners (n = 3; 14%) and decision makers (n = 2; 10%). A total of 84 ideas were generated. Participants highlighted the need to clarify the purpose of the decision aids, the nature of the problem being addressed and the target population. The tools require sociocultural adaptations, better identification of their target population, better description of head CT utility, advantages and related risks, modification of the visual and written representation of the risk of brain injury and head CT use, and locally adapted, patient follow-up plans. CONCLUSIONS This study based on a Nominal Group Technique identified several adaptations for two American decision aids about head CT use for mild traumatic brain injury to support their use in Canada's different healthcare, social, cultural and legal context. These adaptations concerned the target users of the decision aids, the information presented, and how the benefits and risks were communicated in the decision aids. Future steps include prototyping the two adapted decision aids, conducting formative evaluations with actual emergency department patients and clinicians, and measuring the impact of the adapted tools on CT scan use.
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14
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Archambault PM, Guay-Bélanger S, Gélinas V, Giguère A, Ludwig C, Ndiaye MA, Kastner K, Stacey D, Bansback N, Groot G, Légaré F. Patient-Oriented Research from the ISDM 2019 Conference: A Legacy Now More Relevant Than Ever. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:649-652. [PMID: 33063238 PMCID: PMC7561467 DOI: 10.1007/s40271-020-00463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick M Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada.
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada.
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada.
- Centre de recherche intégrée pour un système apprenant en santé et services Sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
| | - Sabrina Guay-Bélanger
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré Universitaire de santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Véronique Gélinas
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services Sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Anik Giguère
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré Universitaire de santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | | | | | | | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré Universitaire de santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
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15
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Vaillancourt C, Charette M, Hall E, McLeod B. Patient and paramedic engagement in prehospital emergency medicine research. CMAJ 2018; 190:S48-S49. [PMID: 30404855 DOI: 10.1503/cmaj.180352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Christian Vaillancourt
- The Ottawa Hospital Research Institute (Vaillancourt), University of Ottawa; The Ottawa Hospital Research Institute (Charette), Ottawa, Ont.; Hall Consulting (Hall); Helping Hands for India (Hall), Kanata, Ont.; Hamilton Paramedic Service (McLeod), Hamilton, Ont.
| | - Manya Charette
- The Ottawa Hospital Research Institute (Vaillancourt), University of Ottawa; The Ottawa Hospital Research Institute (Charette), Ottawa, Ont.; Hall Consulting (Hall); Helping Hands for India (Hall), Kanata, Ont.; Hamilton Paramedic Service (McLeod), Hamilton, Ont
| | - Elizabeth Hall
- The Ottawa Hospital Research Institute (Vaillancourt), University of Ottawa; The Ottawa Hospital Research Institute (Charette), Ottawa, Ont.; Hall Consulting (Hall); Helping Hands for India (Hall), Kanata, Ont.; Hamilton Paramedic Service (McLeod), Hamilton, Ont
| | - Brent McLeod
- The Ottawa Hospital Research Institute (Vaillancourt), University of Ottawa; The Ottawa Hospital Research Institute (Charette), Ottawa, Ont.; Hall Consulting (Hall); Helping Hands for India (Hall), Kanata, Ont.; Hamilton Paramedic Service (McLeod), Hamilton, Ont
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16
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Hamilton CB, Hoens AM, McQuitty S, McKinnon AM, English K, Backman CL, Azimi T, Khodarahmi N, Li LC. Development and pre-testing of the Patient Engagement In Research Scale (PEIRS) to assess the quality of engagement from a patient perspective. PLoS One 2018; 13:e0206588. [PMID: 30383823 PMCID: PMC6211727 DOI: 10.1371/journal.pone.0206588] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/16/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To develop and examine the content and face validity of the Patient Engagement In Research Scale (PEIRS) for assessing the quality of patient engagement in research projects from a patient partner perspective. METHODS Our team of researchers and patient partners conducted a mixed qualitative and quantitative study in three phases. Participants were English-speaking adult patients (including informal caregivers, family members, and friends) with varying experiences as partners in research projects in Canada. 1) Questionnaire items were generated following thematic analysis of in-depth interviews and published literature. 2) A three-round e-Delphi survey process via email correspondence was undertaken to refine and select the items for a provisional PEIRS. 3) Two rounds of cognitive interviewing elicited participants' understanding and opinions of each item and the structure of the PEIRS. RESULTS One hundred and twenty items were generated from 18 interviews and organized across eight themes of meaningful engagement of patients in health research to form an initial questionnaire. The e-Delphi survey and cognitive interviewing each included 12 participants with a range of self-reported diseases, health-related conditions, and use of healthcare services. The e-Delphi survey yielded a 43-item provisional PEIRS. The PEIRS was then reduced to 37 items organized across seven themes after 1) refinement of problems in its instructions and items, and 2) the combining of two themes into one. CONCLUSIONS We developed a 37-item self-reported questionnaire that has demonstrated preliminary content and face validity for assessing the quality of patient engagement in research.
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Affiliation(s)
- Clayon B. Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Alison M. Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, BC, Canada
- BC SUPPORT Unit, Vancouver, BC, Canada
| | - Shanon McQuitty
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, BC, Canada
| | - Annette M. McKinnon
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, BC, Canada
| | - Kelly English
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, BC, Canada
| | - Catherine L. Backman
- Arthritis Research Canada, Richmond, BC, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Tara Azimi
- Arthritis Research Canada, Richmond, BC, Canada
| | | | - Linda C. Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
- BC SUPPORT Unit, Vancouver, BC, Canada
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17
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Luo M, Xue Y, Zhang S, Dong Y, Mo D, Dong W, Qian K, Fang Y, Liang H, Zhang Z. What factors influence older people's intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China. BMJ Open 2018; 8:e021741. [PMID: 30185570 PMCID: PMC6129045 DOI: 10.1136/bmjopen-2018-021741] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Given the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people's intention to enrol in nursing homes. DESIGN A cross-sectional observational study based on the theory of reasoned action was conducted. Survey data were collected from subjects during face-to-face interviews. Structural equation modelling was employed for data analysis. SETTING This study was conducted in six community health service centres in Shanghai, China. Two service centres were selected in urban, suburban and rural areas, respectively. PARTICIPANTS A total of 641 Shanghai residents aged over 60 were surveyed. RESULTS Structural equation modelling analysis showed that the research model fits the data well (χ2/df=2.948, Comparative Fit Index=0.972 and root mean squared error of approximation =0.055). Attitude (β=0.41, p<0.01), subjective norm (β=0.28, p<0.01) and value-added service (β=0.16, p<0.01) were directly associated with enrolment intention, explaining 32% of variance in intention. Attitude was significantly influenced by loneliness (β=-0.08, p<0.05), self-efficacy (β=0.32, p<0.01) and stigma (β=-0.24, p<0.01), while subjective norm was significantly influenced by life satisfaction (β=-0.15, p<0.01) and stigma (β=-0.43, p<0.01). CONCLUSIONS This study advances knowledge regarding the influencing factors of older people's intention to enrol in nursing homes. It suggests that Chinese older persons' perceived stigma has the strongest indirect effect on their intention to enrol in nursing homes. This is unique to the Chinese context and has practical implications for eldercare in China and other Asian countries with similar sociocultural contexts.
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Affiliation(s)
- Mengyun Luo
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yajiong Xue
- College of Business, East Carolina University, Greenville, North Carolina, USA
| | | | - Yuanyuan Dong
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dandan Mo
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Dong
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Kun Qian
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yue Fang
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huigang Liang
- College of Business, East Carolina University, Greenville, North Carolina, USA
| | - Zhiruo Zhang
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
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