1
|
Giannitrapani KF, Lin K, Hafi LA, Maheta B, Isenberg SR. Codesign Use in Palliative Care Intervention Development: A Systematic Review. J Pain Symptom Manage 2024; 68:e235-e253. [PMID: 38909694 DOI: 10.1016/j.jpainsymman.2024.06.007] [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] [Received: 03/21/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
CONTEXT Codesign is a methodology that includes active collaboration between stakeholders in designing solutions and has been used in the development and implementation of palliative care (PC) interventions. OBJECTIVES To synthesize the state of evidence for codesign in the development of PC interventions. METHODS We searched PubMed, EMBASE, and CINAHL for peer-reviewed studies published after 1995 that reported evidence of codesigned interventions and outcomes in patients receiving palliative, hospice, or end-of-life care. We screened studies through independent and blinded dual review within Covidence and assessed study quality with the 2018 Mixed Methods Appraisal Tool. We narratively synthesized codesign duration, engagement approach, stakeholders involved, intervention designs, follow-ups, and outcomes, comparing among codesigns reporting meaningful improvement in outcomes. We created a best practice checklist which we used to evaluate codesign use in each study. RESULTS About 1,036 abstracts and 54 full text articles were screened. Twenty-eight studies met inclusion criteria and were abstracted. Feedback collection modalities ranged from iterative drafting, pilot testing, advisory panels, workshops, focus groups, and interviews. Thirteen studies applied pretesting/prototyping through pretest post-test, focus groups, prototypes, alpha and beta testing, and mock-ups. Eleven studies reported improved outcomes, eight of which utilized iterative codesign. All the studies reporting improved outcomes mentioned meeting with stakeholders at least twice. Two studies met all criteria in our codesign best practice checklist. CONCLUSION Codesigned PC interventions demonstrate high variance in the modality of acquiring feedback and application of codesign. Successful codesign leading to improvement in outcomes is achieved by involving patients, caregivers, and providers in iterating intervention design.
Collapse
Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA; Department of Primary Care and Population Health (K.F.G), Stanford University School of Medicine, Palo Alto, USA.
| | - Kendall Lin
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA
| | - Ladees Al Hafi
- Department of Rehabilitation Sciences (L.A.H), Queen's University, Kingston, Canada
| | - Bhagvat Maheta
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA; College of Medicine (B.M), California Northstate University, Elk Grove, USA
| | - Sarina R Isenberg
- Department of Medicine (S.R.I), Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| |
Collapse
|
2
|
Antonio Sánchez-Cárdenas M, Ximena León-Delgado M, María Vargas-Escobar L, Elizabeth Muñoz Medina S, Milena Buitrago Florian P, Andrade Fonseca D, Esteban Correa-Morales J. Palliative care national plan implementation through stakeholder analysis. BMC Palliat Care 2024; 23:163. [PMID: 38951852 PMCID: PMC11218343 DOI: 10.1186/s12904-024-01427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/03/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care. OBJECTIVE To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country. METHODS A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed. RESULTS Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest. CONCLUSIONS Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.
Collapse
|
3
|
Cromer SJ, Steiner B, York C, Mastrorilli J, Lake GA, Leibowitz S, Simmons L, Steppel-Reznik J, Low G, Fischer MA, Patorno E, Wexler DJ. Successful implementation of a stakeholder engagement program for pharmacoepidemiologic research. Pharmacoepidemiol Drug Saf 2024; 33:e5727. [PMID: 37985010 PMCID: PMC10841974 DOI: 10.1002/pds.5727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Rigorously conducted pharmacoepidemiologic research requires methodologically complex study designs and analysis yet evaluates problems of high importance to patients and clinicians. Despite this, participation in and mechanisms for stakeholder engagement in pharmacoepidemiologic research are not well-described. Here, we describe our approach and lessons learned from engaging stakeholders, of varying familiarity with research methods, in a rigorous multi-year pharmacoepidemiologic research program evaluating the comparative effectiveness of diabetes medications. METHODS We recruited 5 patient and 4 clinician stakeholders; each was compensated for their time. Stakeholders received initial formal training in observational research and pharmacoepidemiologic methods sufficient to enable contribution to the research project. After onboarding, stakeholder engagement meetings were held virtually, in the evening, 2-3 times annually. Each was approximately 90 min and focused on 1-2 specific questions about the project, with preparatory materials sent in advance. RESULTS Stakeholder meeting attendance was high (89%-100%), and all stakeholders engaged with the research project, both during and between meetings. Stakeholders reported positive experiences with meetings, satisfaction, and interest in the research project and its findings, and dedication to the success of the project's goals. They affirmed the value of receiving materials to review in advance and the effectiveness of a virtual platform. Their contributions included prioritizing and suggesting research questions, optimizing written evidence briefs for a lay audience, and guidance on broader topics such as research audience and methods of dissemination. CONCLUSIONS Stakeholder engagement in pharmacoepidemiologic research using complex study designs and analysis is feasible, acceptable, and positively impacts the research project.
Collapse
Affiliation(s)
- Sara J. Cromer
- Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Cassie York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Julianna Mastrorilli
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | | | - Leigh Simmons
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Greg Low
- Massachusetts General Hospital, Boston, MA
| | - Michael A. Fischer
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Elisabetta Patorno
- Harvard Medical School, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Deborah J. Wexler
- Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| |
Collapse
|
4
|
Yamaguchi S, Costello C, Lalonde C, McCarry S, Majnemer A, Shikako K. Supporting families and caregivers of children with disabilities through a parent peer mentor (PPM): experiences from a patient-oriented research network. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:78. [PMID: 37684655 PMCID: PMC10485983 DOI: 10.1186/s40900-023-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The CHILD-BRIGHT Network created a parent peer mentor (PPM) role to support other parents who were engaging as partners in the different research projects and activities of the network. We aim to describe how a PPM functioned to support parent-partners of children with disabilities in research projects within the Network. METHODS In this case study, the PPM approached 50 parent-partners and scheduled a 1-on-1 initial telephone call to offer support for any issues arising. When consent was provided, the PPM recorded interactions with network parent-partners in a communication report in an Excel form. Also, verbatim transcription from one in-depth interview with the PPM was included for data analysis using qualitative description. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2-SF) was used to report on involvement of patient-partners. RESULTS A total of 55 interactions between 25 parent-partners and the PPM were documented between May 2018 and June 2021. The PPM's support and liaison role contributed to adaptation of meeting schedules for parent-partners, amendment of the compensation guidelines, and ensuring that internal surveys and the newsletter were more accessible and engaging. The PPM also facilitated community-building by keeping parent-partners connected with researchers in the Network. Families and caregivers in the Network were comfortable sharing their experiences and emotions with the PPM who was also a parent herself, allowing researchers and the Network to learn more about parents' experiences in partnering with them and how to improve engagement. CONCLUSIONS We highlight the important complementary role that a PPM can play in enhancing patient engagement in research by better understanding the experiences and needs of parent-partners.
Collapse
Affiliation(s)
- Sakiko Yamaguchi
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Carrie Costello
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
| | - Corinne Lalonde
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
| | - Sharon McCarry
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) | MAB-Mackay, 3500, Blv Décarie, Montreal, QC H4A 3J5 Canada
| | - Keiko Shikako
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- CHILD-BRIGHT Patient-Oriented Research Network, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) | MAB-Mackay, 3500, Blv Décarie, Montreal, QC H4A 3J5 Canada
| |
Collapse
|
5
|
Gonzalez M, Ogourtsova T, Zerbo A, Lalonde C, Spurway A, Gavin F, Shikako K, Weiss JA, Majnemer A. Patient engagement in a national research network: barriers, facilitators, and impacts. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:7. [PMID: 36890591 PMCID: PMC9993369 DOI: 10.1186/s40900-023-00418-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Little is known about patient engagement in the context of large teams or networks. Quantitative data from a larger sample of CHILD-BRIGHT Network members suggest that patient engagement was beneficial and meaningful. To extend our understanding of the barriers, facilitators, and impacts identified by patient-partners and researchers, we conducted this qualitative study. METHODS Participants completed semi-structured interviews and were recruited from the CHILD-BRIGHT Research Network. A patient-oriented research (POR) approach informed by the SPOR Framework guided the study. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2-SF) was used to report on involvement of patient-partners. The data were analyzed using a qualitative, content analysis approach. RESULTS Twenty-five CHILD-BRIGHT Network members (48% patient-partners, 52% researchers) were interviewed on their engagement experiences in the Network's research projects and in network-wide activities. At the research project level, patient-partners and researchers reported similar barriers and facilitators to engagement. Barriers included communication challenges, factors specific to patient-partners, difficulty maintaining engagement over time, and difficulty achieving genuine collaboration. Facilitators included communication (e.g., open communication), factors specific to patient-partners (e.g., motivation), and factors such as respect and trust. At the Network level, patient-partners and researchers indicated that time constraints and asking too much of patient-partners were barriers to engagement. Both patient-partners and researchers indicated that communication (e.g., regular contacts) facilitated their engagement in the Network. Patient-partners also reported that researchers' characteristics (e.g., openness to feedback) and having a role within the Network facilitated their engagement. Researchers related that providing a variety of activities and establishing meaningful collaborations served as facilitators. In terms of impacts, study participants indicated that POR allowed for: (1) projects to be better aligned with patient-partners' priorities, (2) collaboration among researchers, patient-partners and families, (3) knowledge translation informed by patient-partner input, and (4) learning opportunities. CONCLUSION Our findings provide evidence of the positive impacts of patient engagement and highlight factors that are important to consider in supporting engagement in large research teams or networks. Based on these findings and in collaboration with patient-partners, we have identified strategies for enhancing authentic engagement of patient-partners in these contexts.
Collapse
Affiliation(s)
- Miriam Gonzalez
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, H3G 1Y5, Canada.
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montréal, H4A 3J1, Canada.
| | - Tatiana Ogourtsova
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, H3G 1Y5, Canada
- The Research Center of the Jewish Rehabilitation Hospital, Centre Intégré de Santé Et de Services Sociaux de Laval, Site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, 3205 PI. Alton-Goldbloom, Laval, QC, H7V 1R2, Canada
| | - Alix Zerbo
- The CHILD-BRIGHT Patient-Oriented Research Network, 5252 Boul de Maisonneuve O., Montréal, H4A 3S5, Canada
| | - Corinne Lalonde
- The CHILD-BRIGHT Patient-Oriented Research Network, 5252 Boul de Maisonneuve O., Montréal, H4A 3S5, Canada
| | - Amy Spurway
- The CHILD-BRIGHT Patient-Oriented Research Network, 5252 Boul de Maisonneuve O., Montréal, H4A 3S5, Canada
| | - Frank Gavin
- The CHILD-BRIGHT Patient-Oriented Research Network, 5252 Boul de Maisonneuve O., Montréal, H4A 3S5, Canada
| | - Keiko Shikako
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, H3G 1Y5, Canada
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montréal, H4A 3J1, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (Mackay Site), 7000 Sherbrooke St. West, H4B 1R3, Montréal, Canada
| | - Jonathan A Weiss
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Annette Majnemer
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, H3G 1Y5, Canada
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montréal, H4A 3J1, Canada
- The Research Center of the Jewish Rehabilitation Hospital, Centre Intégré de Santé Et de Services Sociaux de Laval, Site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, 3205 PI. Alton-Goldbloom, Laval, QC, H7V 1R2, Canada
| |
Collapse
|
6
|
Slaghmuylder Y, Pype P, Van Hecke A, Lauwerier E. Development of an intervention aimed at the prevention and treatment of chronic pain in breast cancer survivors: An intervention mapping approach. PATIENT EDUCATION AND COUNSELING 2023; 108:107618. [PMID: 36586350 DOI: 10.1016/j.pec.2022.107618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Pain is prevalent among breast cancer survivors and can persist for years, impeding quality of life. Both prevention and pain treatment are important. However, this requires an interdisciplinary approach and complex models of care. We report on the design and implementation of an intervention that follows a step-wise care model, aimed at timely and adequate pain follow-up among breast cancer survivors. METHODS We used intervention mapping to guide our planning process. The intervention was developed in co-design with relevant stakeholders, such as breast cancer survivors and healthcare providers. RESULTS An e-learning training was developed aimed at changing healthcare providers' knowledge, beliefs, and interprofessional behaviour regarding pain follow-up. Second, guides were produced to empower patients in talking about pain and stimulate referral to other disciplines. CONCLUSION To achieve change in pain follow-up, multiple levels should be addressed. Additionally, the implementation and adoption of an intervention opposes challenges. Intervention mapping can serve as a theory-based and data-driven approach for decision-making during planning. PRACTICE IMPLICATIONS This study can inform others about how to prepare for the development and implementation of an intervention. The developed intervention can also be adapted according to the target population and context, and used for other cancer populations.
Collapse
Affiliation(s)
- Yaël Slaghmuylder
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Peter Pype
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| |
Collapse
|
7
|
Marquis-Gravel G, Faulkner M, Merritt G, Farrehi P, Zemon N, Robertson HR, Jones WS, Kraschnewski J. Importance of patient engagement in the conduct of pragmatic multicenter randomized controlled trials: The ADAPTABLE experience. Clin Trials 2023; 20:31-35. [PMID: 35999816 DOI: 10.1177/17407745221118559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Actively engaging patient partners in the conduct of trials is crucial to ensure the studies answer genuine, patient-centered, unmet clinical needs, and to facilitate participant recruitment and retention. The aim of this article is to demonstrate the feasibility of patient engagement within a large pragmatic multicenter randomized controlled trial, specifically for the purposes of dissemination of study information/updates and to favorize recruitment and retention. METHODS In the patient-centric, pragmatic ADAPTABLE randomized trial, transparent and timely dissemination of information on the study updates to the trial participants was undertaken to create meaningful engagement and to facilitate retention. A national panel of patient partners, the Adaptors, were directly involved in this information dissemination strategy, and study participants were engaged both nationally and locally to design recruitment methods iteratively during the conduct of the trial. All Adaptors had a lived experience with cardiovascular disease. RESULTS Adaptors attended bi-weekly meetings facilitated by the director of the study's patient-powered research network. They drafted and/or edited newsletters and ad hoc educational information written in a lay-friendly manner for study participants, which were regularly distributed to the ADAPTABLE community, in addition to online forums where participants could share their experience of their involvement in ADAPTABLE. To spur recruitment, a patient-driven initiative was to draft letters sharing their story, which were distributed by the local study teams. Patient partners thought that using patients' voice to provide their perspectives on why they believed this project was important would be more engaging for prospective participants than traditional approaches. CONCLUSIONS ADAPTABLE's experience has demonstrated the feasibility of engaging patients as partners in the conduct of a large-scale, multi-center, pragmatic randomized controlled trial. Future trials should embrace and iteratively improve this model by engaging patient partners as early as study protocol development and funding applications, and quantify its impact on the effectiveness and value of the trial.
Collapse
Affiliation(s)
| | - Madelaine Faulkner
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Peter Farrehi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - W Schuyler Jones
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
| | - Jennifer Kraschnewski
- Departments of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
8
|
Kraschnewski JL, Kong L, Bryce CL, Francis EB, Poger JM, Lehman EB, Helbling S, Soleymani T, Mancoll RE, Villalobos V, Yeh HC. Intensive behavioral Therapy for weight loss in patients with, or At-Risk of, type 2 Diabetes: Results from the PaTH to health diabetes study. Prev Med Rep 2022; 31:102099. [PMID: 36820381 PMCID: PMC9938299 DOI: 10.1016/j.pmedr.2022.102099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Intensive behavioral therapy (IBT) is an important component of obesity treatment and can reduce the risk of type 2 diabetes (T2DM). Objective was to compare the effectiveness of IBT to usual care in achieving weight loss in two study cohorts within PaTH Network: T2DM and At-Risk of T2DM. The TD2M cohort was defined as age 18 years and older with an indication of T2DM in the EHR based on a validated algorithm and at least 2 outpatient primary care visits. The At-Risk of T2DM cohort was defined by a BMI ≥ 25 kg/m2. The primary outcome was weight change within 1-year of index date. Mixed-effects models assessed the effectiveness of IBT by comparing the changes between study groups. Between 2009 and 2020, a total of 567,908 patients were identified in the T2DM cohort and2,054,256 patients in the At-Risk of T2DM cohort. Both IBT patients and matched non-IBT patients in the T2DM cohort had decreased mean weight (primary outcome) (-1.56 lbs, 95 %CI: -1.88, -1.24 vs -1.70 lbs, 95 %CI: -1.95, -1.44) in 1-year after index date. In the At-Risk of T2DM cohort, both IBT and non-IBT patients experienced weight gain and resultant increased BMI. Patients with more than one IBT visit gained less weight than those with only one visit (1.22 lbs, 95 %CI: 0.82, 1.62 vs 6.72 lbs, 95 %CI: 6.48, 6.97; p < 0.001). IBT was unlikely to result in clinically significant weight loss. Barriers to utilizing IBT require further research to ensure broader adoption of obesity management in primary care.
Collapse
Affiliation(s)
- Jennifer L. Kraschnewski
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Cindy L. Bryce
- Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica B. Francis
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer M. Poger
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA,Corresponding author at: Penn State College of Medicine, 90 Hope Drive, Suite 1103, Mail Code A145, Hershey, PA 17033, USA.
| | - Erik B. Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Taraneh Soleymani
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Rebecca E. Mancoll
- Department of Medicine, Division of General Internal Medicine, UPMC, Pittsburgh, PA, USA
| | | | - Hsin-Chieh Yeh
- Department of Medicine, School of Medicine, Johns Hopkins University, Maryland, USA
| |
Collapse
|
9
|
Integrating Care from Home to Hospital to Home: Using Participatory Design to Develop a Provincial Transitions in Care Guideline. Int J Integr Care 2022; 22:16. [PMID: 35634250 PMCID: PMC9122004 DOI: 10.5334/ijic.5674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Patients worldwide experience fragmented and uncoordinated care as they transition between primary and acute care. To improve system integration and outcomes for patients, in 2017/2018 Alberta Health Services (largest health services delivery organization in Canada) called for a coordinated approach to improve transitions in care (TiC). Healthcare leadership responded by initiating the development of a province-wide guideline outlining core components of effective transitions in care. This case study highlights the extensive design process used to develop this guideline, with a focus on the participatory design (PD) approach used throughout. Methods: An iterative, mixed methods PD approach was used to engage over 750 stakeholders through the following activities to establish Guideline content: i) learning collaborative; ii) design-team; iii) targeted online surveys; iv) primary care stakeholder consultation; v) modified Delphi panel; and vi) patient advisory committee. Results: The result was Alberta’s first guideline for supporting patients through TiC: “Alberta’s Home to Hospital to Home Transitions Guideline”. Conclusion: The extensive design process used to create the Guideline was instrumental in establishing content, encouraging system integration, and creating conditions to support provincial implementation. While intended to improve and standardize patient care in Alberta, the methods used and lessons learned throughout the development of the Guideline are applicable internationally.
Collapse
|
10
|
Co-creating the Patient Partner Guide by a Multiple Chronic Conditions Team of Patients, Clinicians, and Researchers: Observational Report. J Gen Intern Med 2022; 37:73-79. [PMID: 35349025 PMCID: PMC8960693 DOI: 10.1007/s11606-021-07308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/24/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Engaging patients as partners can influence research, with rewards and deterrents. The authors are researchers and patient co-investigators who collaborated on a comparative effectiveness, randomized controlled study of a structured quality improvement (QI) process to improve behavioral health and primary care integration for people managing multiple chronic conditions (MCC). Patient co-investigators responded to a gap in available resources to support study clinics in partnering with their own patients in QI and co-created the Patient Partner Guide (PPG). OBJECTIVE Describe the development of the PPG, its use by clinics undertaking the QI project, and research team partnerships. DESIGN Observational report of study intervention component. PARTICIPANTS Diverse patients and family members managing MCC and members of their primary care clinics. INTERVENTION The PPG component of the study intervention is a five-step workbook providing practical tools and resources to sustain partnerships across clinic QI team members, including patient partners. The process of developing the PPG relied on relationship-building tools that were iteratively assessed, practiced, improved, and incorporated into the PPG under the leadership of patient co-investigators. MAIN MEASURES Observations related to PPG use and patient partner inclusion in clinic QI; impact on the research team. KEY RESULTS Of 20 clinics, 6 engaged patients as full partners on QI teams. Clinics found resistance in partnering and challenges in using the PPG but valued the material and their partners' contributions. Similarly, engagement of patient co-investigators in research brought a shift in perspective to team members. The PPG is available and was adapted for use by research teams. CONCLUSIONS Engagement of patients and other stakeholders in research can be transformative and productive. Building relationships through meaningful work benefits others, and in turn, the research process. This approach can enhance clinical care QI and may result in substantial contributions to the conduct of research. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02868983.
Collapse
|
11
|
Evaluating Medical Therapy for Calcific Aortic Stenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2354-2376. [PMID: 34857095 DOI: 10.1016/j.jacc.2021.09.1367] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Despite numerous promising therapeutic targets, there are no proven medical treatments for calcific aortic stenosis (AS). Multiple stakeholders need to come together and several scientific, operational, and trial design challenges must be addressed to capitalize on the recent and emerging mechanistic insights into this prevalent heart valve disease. This review briefly discusses the pathobiology and most promising pharmacologic targets, screening, diagnosis and progression of AS, identification of subgroups that should be targeted in clinical trials, and the need to elicit the patient voice earlier rather than later in clinical trial design and implementation. Potential trial end points and tools for assessment and approaches to implementation and design of clinical trials are reviewed. The efficiencies and advantages offered by a clinical trial network and platform trial approach are highlighted. The objective is to provide practical guidance that will facilitate a series of trials to identify effective medical therapies for AS resulting in expansion of therapeutic options to complement mechanical solutions for late-stage disease.
Collapse
|
12
|
Enhancing community engagement in Patient-Centered Outcomes Research: Equipping learners to thrive in translational efforts. J Clin Transl Sci 2021; 5:e172. [PMID: 34733548 PMCID: PMC8532187 DOI: 10.1017/cts.2021.835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
Community engagement is a critical component of translational research. Innovative educational approaches to support meaningful involvement of stakeholders in clinical research allows for bidirectional learning and greater engagement in translational efforts. Our Penn State Community-Engaged Research Core (CeRC) team has developed an innovative research curriculum for a variety of stakeholders, including patient partners, organizational representatives, and Community Health Workers (CHWs). This brief report will outline unique curricular approaches, guided by adult learning principles, to enhance stakeholder education and engagement in activities. Initial evidence of impact on learning is also reported.
Collapse
|
13
|
Kwan BM, Ytell K, Coors M, DeCamp M, Morse B, Ressalam J, Reno JE, Himber M, Maertens J, Wearner R, Gordon K, Wynia MK. A stakeholder engagement method navigator webtool for clinical and translational science. J Clin Transl Sci 2021; 5:e180. [PMID: 34849255 PMCID: PMC8596067 DOI: 10.1017/cts.2021.850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/09/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022] Open
Abstract
Stakeholder engagement is increasingly expected by funders and valued by researchers in clinical and translational science, yet many researchers lack access to expert consultation or training in selecting appropriate stakeholder engagement methods. We describe the development of a novel Stakeholder Engagement Navigator webtool. We conducted an environmental scan and literature review, along with investigator interviews, surveys, and engagement expert facilitated group discussion. We formally reviewed and cataloged 29 distinct engagement methods. To develop the webtool, we used an iterative design process that followed Design Thinking phases: empathize, define, ideate, prototype, and test. As prioritized during user testing, the Stakeholder Engagement Navigator webtool both educates and guides investigators in selecting an engagement method based on key criteria. The V1.0 Navigator webtool filters methods first by purpose of engagement (noted by 62% of users as the highest priority criteria), then by budget, time per stakeholder interaction, and total interactions. The tool is available at DICEMethods.org. The Stakeholder Engagement Navigator webtool is a user-centered, interactive webtool suitable for use by researchers seeking guidance on appropriate stakeholder engagement methods for clinical and translational research projects.
Collapse
Affiliation(s)
- Bethany M. Kwan
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kate Ytell
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marilyn Coors
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew DeCamp
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brad Morse
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenna E. Reno
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Meleah Himber
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julie Maertens
- The Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robyn Wearner
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kaylee Gordon
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew K. Wynia
- The Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Colorado School of Public Health, Department of Health Systems Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
| | - Judy Needham
- Canadian Cancer Trials Group, Kingston, ON K7L 3N6, Canada;
| | - Stephen Sundquist
- Canadian Cancer Clinical Trials Network (3CTN), Toronto, ON M5G 0A3, Canada;
| | - Dominique Johnson
- McPeak-Sirois Group for Clinical Research in Breast Cancer, Montreal, QC H2Y 2H2, Canada;
| | - Sabrina Hanna
- The Cancer Collaborative, Montreal, QC H7W 0C3, Canada;
| | | | | | - Patricia Steele
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | - Sarita Benchimol
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| | | | - Barry D. Stein
- Colorectal Cancer Canada, Montreal, QC H3G 1J1, Canada; (P.S.); (S.B.)
| |
Collapse
|
15
|
Filling the Public Health Science Gaps for Diabetes With Natural Experiments. Med Care 2020; 58 Suppl 6 Suppl 1:S1-S3. [PMID: 32412947 DOI: 10.1097/mlr.0000000000001330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|