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Karimijashni M, Ramsay T, Beaulé PE, Poitras S. Strategies to Manage Poorer Outcomes After Hip or Knee Arthroplasty: A Narrative Review of Current Understanding, Unanswered Questions, and Future Directions. Musculoskeletal Care 2024; 22:e1921. [PMID: 39075675 DOI: 10.1002/msc.1921] [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: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Although hip or knee arthroplasty is generally a successful intervention, it is documented that 15%-30% of patients undergoing arthroplasty report suboptimal outcomes. This narrative review aims to provide an overview of the key findings concerning the management of poorer outcomes after hip or knee arthroplasty. METHOD A comprehensive search of articles was conducted up to November 2023 across three electronic databases. Only studies written in English were included, with no limitations applied regarding study design and time. RESULT Efficiently addressing poorer outcomes after arthroplasty necessitates a thorough exploration of appropriate methods for assessing recovery following hip or knee arthroplasty, ensuring accurate identification of patients at risk or experiencing poorer recovery. When selecting appropriate outcome measure tools, various factors should be taken into consideration, including understanding patients' priorities throughout the recovery process, assessing psychometric properties of outcome measure tools at different time points after arthroplasty, understanding how to combine/reconcile provider-assessed and patient-reported outcome measures, and determining the appropriate methods to interpret outcome measure scores. However, further research in these areas is warranted. In addition, the identification of key modifiable factors affecting outcomes and the development of interventions to manage these factors are needed. CONCLUSION There is growing attention paid to delivering interventions for patients at risk or not optimally recovering following hip or knee arthroplasty. To achieve this, it is essential to identify the most appropriate outcome measure tools, factors associated with poorer recovery and management of these factors.
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Affiliation(s)
- Motahareh Karimijashni
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Pirayeh N, Shahoori F, Goharpey S, Mostafaee N. Responsiveness of a Persian version of the international knee documentation committee and the anterior cruciate ligament-quality of life questionnaires in athletes with anterior cruciate ligament reconstruction following physiotherapy intervention. Physiother Theory Pract 2024:1-9. [PMID: 39099189 DOI: 10.1080/09593985.2024.2388111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION The International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament - Quality of Life Questionnaire (ACL-QOL) are frequently used patient-reported instruments designed for individuals with anterior cruciate ligament reconstruction (ACL-R). PURPOSE To evaluate responsiveness and determine minimal important change (MIC) for the Persian-version of IKDC and ACL-QOL in athletes with ACL-R following physiotherapy intervention. METHOD One hundred athletes with ACL-R, undergoing 16-week physiotherapy completed IKDC and ACL-QOL at weeks 4 and 20 post ACL-R. Participants also rated their overall changes on a 7-point global rating of change at follow-up. Responsiveness was evaluated using the receiver operating characteristics (ROC) curve and correlation analysis. In addition, the minimal important change (MIC) was determined on the ROC curve. RESULTS Acceptable responsiveness was reached by the IKDC and most of the subscales of ACL-QOL (area under the ROC curve (AUC) of 0.72-0.79). Also, the subscale of Lifestyle issues of ACL-QOL (AUC of 0.81 (95% CI = 0.72-0.89) and the overall of ACL-QOL (AUC of 0.87 (95% CI = 0.80-0.93) showed the good level of responsiveness. The MIC scores of IKDC and the Overall ACL-QOL were determined 25 and 26 points, respectively. CONCLUSION The IKDC and ACL-QOL questionnaires have adequate responsiveness and are able to measure the change in athletes with ACL-R following a 16-week physiotherapy intervention.
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Affiliation(s)
- Nahid Pirayeh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Shahoori
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Mostafaee
- Department of Physiotherapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Ye G, Zhu Y, Bao W, Zhou H, Lai J, Zhang Y, Xie J, Ma Q, Luo Z, Ma S, Guo Y, Zhang X, Zhang M, Niu X. The Long COVID Symptoms and Severity Score: Development, Validation, and Application. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1085-1091. [PMID: 38641060 DOI: 10.1016/j.jval.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The primary focus of this research is the proposition of a methodological framework for the clinical application of the long COVID symptoms and severity score (LC-SSS). This tool is not just a self-reported assessment instrument developed and validated but serves as a standardized, quantifiable means to monitor the diverse and persistent symptoms frequently observed in individuals with long COVID. METHODS A 3-stage process was used to develop, validate, and establish scoring standards for the LC-SSS. Validation measures included correlations with other patient-reported measures, confirmatory factor analysis, Cronbach's α for internal consistency, and test-retest reliability. Scoring standards were determined using K-means clustering, with comparative assessments made against hierarchical clustering and the Gaussian Mixture Model. RESULTS The LC-SSS showed correlations with EuroQol 5-Dimension 5-Level (rs = -0.55), EuroQol visual analog scale (rs = -0.368), Patient Health Questionnaire-9 (rs = 0.538), Beck Anxiety Inventory (rs = 0.689), and Insomnia Severity Index (rs = 0.516), confirming its construct validity. Structural validity was good with a comparative fit index of 0.969, with Cronbach's α of 0.93 indicating excellent internal consistency. Test-retest reliability was also satisfactory (intraclass correlation coefficient 0.732). K-means clustering identified 3 distinct severity categories in individuals living with long COVID, providing a basis for personalized treatment strategies. CONCLUSIONS The LC-SSS provides a robust and valid tool for assessing long COVID. The severity categories established via K-means clustering demonstrate significant variation in symptom severity, informing personalized treatment and improving care quality for patients with long COVID.
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Affiliation(s)
- Gengchen Ye
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yanan Zhu
- Medical Imaging Centre, Ankang Central Hospital, Ankang, Shaanxi Province, China; School of Medicine, Ankang University, Ankang, Shaanxi Province, China
| | - Wenrui Bao
- School of Future Technology, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Heping Zhou
- Medical Imaging Centre, Ankang Central Hospital, Ankang, Shaanxi Province, China
| | - Jiandong Lai
- Medical Imaging Centre, Ankang Central Hospital, Ankang, Shaanxi Province, China
| | - Yuchen Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Juanping Xie
- School of Medicine, Ankang University, Ankang, Shaanxi Province, China
| | - Qingbo Ma
- Master of Biomedical Engineering (Research-oriented), Ankang Vocational and Technical College, Ankang, Shaanxi Province, China
| | - Zhaoyao Luo
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Shaohui Ma
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yichu Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xuanting Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Xuan Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Hong JSW, Ostinelli EG, Kamvar R, Smith KA, Walsh AEL, Kabir T, Tomlinson A, Cipriani A. An online evidence-based dictionary of common adverse events of antidepressants: a new tool to empower patients and clinicians in their shared decision-making process. BMC Psychiatry 2024; 24:532. [PMID: 39049079 PMCID: PMC11270875 DOI: 10.1186/s12888-024-05950-6] [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: 03/08/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Adverse events (AEs) are commonly reported in clinical studies using the Medical Dictionary for Regulatory Activities (MedDRA), an international standard for drug safety monitoring. However, the technical language of MedDRA makes it challenging for patients and clinicians to share understanding and therefore to make shared decisions about medical interventions. In this project, people with lived experience of depression and antidepressant treatment worked with clinicians and researchers to co-design an online dictionary of AEs associated with antidepressants, taking into account its ease of use and applicability to real-world settings. METHODS Through a pre-defined literature search, we identified MedDRA-coded AEs from randomised controlled trials of antidepressants used in the treatment of depression. In collaboration with the McPin Foundation, four co-design workshops with a lived experience advisory panel (LEAP) and one independent focus group (FG) were conducted to produce user-friendly translations of AE terms. Guiding principles for translation were co-designed with McPin/LEAP members and defined before the finalisation of Clinical Codes (CCs, or non-technical terms to represent specific AE concepts). FG results were thematically analysed using the Framework Method. RESULTS Starting from 522 trials identified by the search, 736 MedDRA-coded AE terms were translated into 187 CCs, which balanced key factors identified as important to the LEAP and FG (namely, breadth, specificity, generalisability, patient-understandability and acceptability). Work with the LEAP showed that a user-friendly language of AEs should aim to mitigate stigma, acknowledge the multiple levels of comprehension in 'lay' language and balance the need for semantic accuracy with user-friendliness. Guided by these principles, an online dictionary of AEs was co-designed and made freely available ( https://thesymptomglossary.com ). The digital tool was perceived by the LEAP and FG as a resource which could feasibly improve antidepressant treatment by facilitating the accurate, meaningful expression of preferences about potential harms through a shared decision-making process. CONCLUSIONS This dictionary was developed in English around AEs from antidepressants in depression but it can be adapted to different languages and cultural contexts, and can also become a model for other interventions and disorders (i.e., antipsychotics in schizophrenia). Co-designed digital resources may improve the patient experience by helping to deliver personalised information on potential benefits and harms in an evidence-based, preference-sensitive way.
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Affiliation(s)
- James S W Hong
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
| | - Edoardo G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | | | - Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | | | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anneka Tomlinson
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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de Lemus M, Cattinari MG, Pascual SI, Medina J, García M, Magallón A, Dumont M, Rebollo P. Identification of the most relevant aspects of spinal muscular atrophy (SMA) with impact on the quality of life of SMA patients and their caregivers: the PROfuture project, a qualitative study. J Patient Rep Outcomes 2024; 8:78. [PMID: 39044101 PMCID: PMC11266339 DOI: 10.1186/s41687-024-00758-0] [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: 12/19/2023] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND SMA is a hereditary neuromuscular disease that causes progressive muscle weakness and atrophy. Several studies have shown that the burden of SMA is very high at many levels. Functional assessment tools currently used do not completely address the impact of the disease in patients' life. The objective of this qualitative study was to identify aspects of SMA that are relevant to patients and to design items useful for assessment purposes. RESULTS Five focus group sessions were run during an annual SMA families meeting in Madrid, Spain. Focus groups were composed by parents of SMA type I children, sitter children type II-III, parents of sitter children type II-III, adult patients, and parents of walker children. Two trained facilitators conducted the focus groups using a semi-structured guideline to cover previously agreed topics based on the input of a Scientific and Patient Advisory Committee. The guideline was adapted for the different groups. According to what was communicated by participants, SMA entails a high burden of disease for both patients and their parents. Burden was perceived in physical, psychological, and social areas. Patient's physical domain was the most relevant for participants, especially for parents of non-ambulant children, followed by limitations of motor scales to capture all changes, parents psychological burden, treatment expectations and patient's psychological burden. Ten domains were the main areas identified as impacted by the disease: mobility and independence, fatigue and fatigability, infections and hospital consultations, scoliosis and contractures, vulnerability, pain, feeding, time spent in care, breathing, and sleep and rest. CONCLUSIONS This study confirms the necessity of evaluating other aspects of the disease that are not assessed in the functional motor scale. Measures of other aspects of the disease, such as pain, fatigue, feeding, should be also considered. A patient-reported outcomes instrument measuring such aspects in a valid and reliable way would be very useful. This study generated a list of new items relevant to be systematically measured in the assessment of the impact of SMA on the patients' everyday life.
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Affiliation(s)
- Mencía de Lemus
- Fundación Atrofia Muscular Espinal (FundAME), Calle Nuria 93, 1ºC, Madrid, 28034, Spain
- SMA-Europe, Freiburg, Germany
- Committee of Advanced Therapies at the European Medicines Agency, London, UK
| | - Maria G Cattinari
- Fundación Atrofia Muscular Espinal (FundAME), Calle Nuria 93, 1ºC, Madrid, 28034, Spain.
| | - Samuel I Pascual
- Department of Neurology, Hospital Universitario La Paz - Madrid, Madrid, Spain
| | - Julita Medina
- Rehabilitation and Physical Unit Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mar García
- Department of Neurology, Hospital Universitario La Paz - Madrid, Madrid, Spain
| | | | - María Dumont
- Fundación Atrofia Muscular Espinal (FundAME), Calle Nuria 93, 1ºC, Madrid, 28034, Spain
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Anderson M, van Kessel R, Wood E, Stokes A, Fistein J, Porter I, Mossialos E, Valderas JM. Understanding factors impacting patient-reported outcome measures integration in routine clinical practice: an umbrella review. Qual Life Res 2024:10.1007/s11136-024-03728-7. [PMID: 39023733 DOI: 10.1007/s11136-024-03728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice. METHODS An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework. RESULTS 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators. CONCLUSIONS The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.
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Affiliation(s)
- Michael Anderson
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK.
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Eleanor Wood
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Adam Stokes
- Centre for Global Health, St Georges, University of London, London, UK
| | - Jon Fistein
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
- Centre for Research On Health Systems Performance, National University of Singapore, Singapore, Singapore
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Kang KA, Kim SJ. Spiritual Care Expectations Among Cancer and Noncancer Patients With Life-Threatening Illnesses. Cancer Nurs 2024; 47:E269-E278. [PMID: 36867017 DOI: 10.1097/ncc.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Spirituality is a core element in holistic nursing care. Therefore, it is necessary to understand the spiritual care expectations of cancer and noncancer patients with life-threatening illnesses. OBJECTIVE The aim of this study was to identify the spiritual care expectations of vulnerable patients with life-threatening illnesses. INTERVENTIONS/METHODS This study uses both quantitative and qualitative approaches, and data were collected from 232 patients. For quantitative data, we used the Nurse Spiritual Therapeutics Scale (NSTS), which comprises 20 items. Qualitative data were collected using an open-ended question. Quantitative data were analyzed using descriptive statistics, independent t tests, 1-way analysis of variance, and item and factor analysis. Qualitative data were analyzed using content analysis. RESULTS The mean score of spiritual care expectations ranged from 2.27 to 3.07. There was a significant difference in NSTS mean score between cancer and noncancer patients. In exploratory factor analysis, NSTS was extracted into 3 factors and items belonging to the 3 factors showed similarity between cancer and noncancer patients. Qualitative data using content analysis revealed the following 3 themes: "treat with respect," "religious support," and "comfort with presence." The 3 factors corresponded with 3 themes: factor I versus "treat with respect," factor II versus "religious ritual," and factor III versus "comfort with presence." CONCLUSIONS Spiritual care expectations of cancer and non-cancer patients with life-threatening illnesses were identified and the findings provide valuable data regarding the expectations of patients' spiritual care. IMPLICATIONS FOR PRACTICE Our findings emphasize integrating patient-reported outcomes with spiritual care to stimulate patient-centered care, thus promoting holistic palliative or end-of-life care.
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Affiliation(s)
- Kyung-Ah Kang
- Author Affiliations: College of Nursing, Sahmyook University, Seoul (Dr Kang); and School of Nursing, Hallym University, Chuncheon, Gangwon-do, Republic of Korea (Dr Kim)
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Murphy Y, Winzer A, Ogilvie L, Mayoh M, McLeod KE. Bringing experiences of healthcare in custody into quality improvement. Healthc Manage Forum 2024; 37:263-267. [PMID: 38429935 PMCID: PMC11295421 DOI: 10.1177/08404704241235891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Patient experience is an essential component of safe and high-quality healthcare, yet rarely examined in the context of carceral settings. This article describes a project undertaken by the Ontario Ministry of the Solicitor General to collect evidence and perspectives on how to bring patient experiences of healthcare services delivered in provincial correctional facilities into ongoing quality improvement work. We first conducted a scoping review and jurisdictional scan to learn from existing processes and experiences. We then engaged frontline healthcare providers delivering services in custody and people with recent experience of incarceration regarding priority measures and processes for data collection and mechanisms for implementing evidence-based change. This article describes methods used to engage stakeholders, including a survey and focus groups, as well as key lessons learned. This work is relevant to readers experiencing barriers to patient engagement, interested in collaborative research processes, and developing services for people who have experienced incarceration.
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Affiliation(s)
- Yoko Murphy
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Andrea Winzer
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Linda Ogilvie
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Melanie Mayoh
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Katherine E. McLeod
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Lormans T, de Graaf E, de Vries S, Leget C, Teunissen S. 'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration. Palliat Care Soc Pract 2024; 18:26323524241260426. [PMID: 38911602 PMCID: PMC11191620 DOI: 10.1177/26323524241260426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it. Objective This study aims to identify what patients need when using the USD-4D in clinical palliative care. Design A generic qualitative design with primary and secondary analyses of semistructured interviews. Methods Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis. Results Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach. Conclusion For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.
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Affiliation(s)
- Tom Lormans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584CG, The Netherlands
| | - Everlien de Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sita de Vries
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Leget
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bloemen B, Oortwijn W, van der Wilt GJ. Understanding the Normativity of Health Technology Assessment: Ontological, Moral, and Epistemological Commitments. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00487-x. [PMID: 38884685 DOI: 10.1007/s10728-024-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
The inherent normativity of HTA can be conceptualized as a result of normative commitments, a concept that we further specify to encompass moral, epistemological and ontological commitments at play in the practice of HTA. Based on examples from literature, and an analysis of the example of assessing Non-Invasive Prenatal Testing (NIPT), we will show that inevitable normative decisions in conducting an assessment commits the HTA practitioner to moral (regarding what makes a health technology desirable), ontological (regarding which effects of health technology are conceivable), and epistemological (regarding how to obtain reliable information about health technology) norms. This highlights and supports the need for integrating normative analysis and stakeholder participation, providing guidance to HTA practitioners when making normative choices. This will foster a shared understanding between those who conduct, use, or are impacted by assessments regarding what are conceivable and desirable outcomes of using health technology, and how to collect reliable information to assess whether these outcomes are (going to be) realized. It also provides more insight into the implications of different normative choices.
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Affiliation(s)
- Bart Bloemen
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wija Oortwijn
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
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Ishaque S, Roberts RM, Karnon J, Thomas D, Salter AB. Adaptation and content validation of measure yourself medical outcomes profile (MYMOP) for 7-11 year-old children. Qual Life Res 2024:10.1007/s11136-024-03702-3. [PMID: 38874698 DOI: 10.1007/s11136-024-03702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The Measure Yourself Medical Outcome Profile (MYMOP) is an individualised tool designed for adults but used with children without any evidence of validation in this population. Individualised instruments are patient-specific rather than disease-specific and therefore can be applied across various health conditions. This study sought to adapt, and content validate the MYMOP for application in 7-11 year old children. METHODS There were two main phases of the four iterations: expert consultation (three rounds) and interviews with child-parent pairs at the Outpatient clinics of a Children's Hospital. Thematic analysis was undertaken using an inductive, interpretative approach. RESULTS Four paediatricians completed the first survey, five paediatricians participated in the focus group, and four paediatric health-related quality of life (HRQOL) research experts completed the second survey. Several changes were recommended to the MYMOP by the expert groups. Twenty-five children (17 general medicine, and 8 diabetes/endocrine clinic) aged 7-11 years completed the draft paediatric MYMOP (P-MYMOP) and were interviewed. Results demonstrated that the majority of participants were able to identify their own problems and activity limitations, and all participants understood the 7-point faces scale. Most parents and children perceived that the P-MYMOP would be useful to complete before clinic appointments. CONCLUSIONS The P-MYMOP is the first content-validated generic individualised HRQOL measure for children 7-11 years old. Given that validation is an iterative process, further research to assess its feasibility, reliability, and construct validity is required.
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Affiliation(s)
- S Ishaque
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - R M Roberts
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - D Thomas
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - A B Salter
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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12
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Sommerfelt K, Schei T, Seton KA, Carding SR. Assessing Functional Capacity in Myalgic Encephalopathy/Chronic Fatigue Syndrome: A Patient-Informed Questionnaire. J Clin Med 2024; 13:3486. [PMID: 38930014 PMCID: PMC11204454 DOI: 10.3390/jcm13123486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an acquired disease with significant morbidity that affects both children and adults. Post-exertional malaise is a cardinal symptom of ME/CFS and impacts a patient's functional capacity (FC). The absence of effective tools to assess FC has significant consequences for timely diagnosis, clinical follow-up, assessments for patient disability benefits, and research studies. In interventional studies, the inability to assess FC can result in an incomplete assessment of the potential benefit of the intervention, leading to beneficial treatment outcomes being missed. Methods: Using extensive, repeated patient feedback, we have developed a new questionnaire, FUNCAP, to accurately assess FC in ME/CFS patients. The questionnaire consists of eight domains divided by activity types: A. personal hygiene/basic functions, B. walking/movement, C. being upright, D. activities in the home, E. communication, F. activities outside the home, G. reactions to light and sound, and H. concentration. Results: Through five rounds of anonymous web-based surveys and a further test-retest validation round, two versions of the questionnaire were developed: a longer version comprising 55 questions (FUNCAP55), developed for improved diagnostic and disability benefit/insurance FC assessments; and a shorter version (FUNCAP27) for clinical patient follow-up and potential use in research. Good reliability and validity and negligible floor and ceiling effects were found, with comparable findings in all aspects in both a large Norwegian (n = 1263) and a separate English-language international sample (n = 1387) demonstrating the validity and reliability of FUNCAP. Conclusions: Our findings support the utility of FUNCAP as an effective, reliable and valid tool for assessing FC in ME/CFS patients.
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Affiliation(s)
- Kristian Sommerfelt
- Children and Youth Clinic, Institute of Clinical Medicine 2, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway
| | - Trude Schei
- Norwegian ME Association, Nedre Slottsgate 4 M, 0157 Oslo, Norway
| | - Katharine A. Seton
- Quadram Institute Biosciences, Norwich Research Park, Norwich NR4 7UQ, UK; (K.A.S.)
| | - Simon R. Carding
- Quadram Institute Biosciences, Norwich Research Park, Norwich NR4 7UQ, UK; (K.A.S.)
- Norwich Medical School, University East Anglia, Norwich NR4 7TJ, UK
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13
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Tremblay M, Brais B, Asselin V, Buffet M, Girard A, Girard D, Berbiche D, Gagnon C. The Development of a New Patient-Reported Outcome Measure in Recessive Ataxias: The Person-Reported Ataxia Impact Scale. CEREBELLUM (LONDON, ENGLAND) 2024; 23:512-522. [PMID: 37165279 DOI: 10.1007/s12311-023-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
Autosomal recessive cerebellar ataxias (ARCAs) are inherited neurological disorders that can affect both the central and peripheral nervous systems. To assess the effects of interventions according to the perception of people affected, patient-reported outcome measures (PROMs) must be available. This paper presents the development process of the Person-Reported Ataxia Impact Scale (PRAIS), a new PROM in recessive ataxias, and the documentation of its content validity, interpretability, and construct validity (structural and discriminant). The development followed the PROMIS framework and the Food and Drug Administration guidelines. A mixed-method study design was used to develop the PROM. A systematic review of the literature, semistructured interviews, and discussion groups was conducted to constitute an item pool. Experts' consultation helped formulate items, and the questionnaire was sent online to be completed by people affected. Statistical analyses were performed to assess the structural and discriminant validity. A total of 125 people affected by recessive ataxia completed the questionnaire. The factor analysis confirmed the three components: physical functions and activities, mental functions, and social functions. The statistical analysis showed that it can discriminate between stages of mobility and level of autonomy. It showed very good levels of internal consistency (0.79 to 0.89). The Person-Reported Ataxia Impact Scale (PRAIS) is a 38-item questionnaire that assesses the manifestations and impacts of the disease according to the perception of people affected by recessive ataxia. It can be used in clinical and research settings.
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Affiliation(s)
- Marjolaine Tremblay
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada.
- Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC, J1K 2R1, Canada.
| | - Bernard Brais
- McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A 0G4, Canada
- Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Véronique Asselin
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada
| | - Martin Buffet
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada
| | - André Girard
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada
| | - Denis Girard
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada
| | - Djamal Berbiche
- Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC, J1K 2R1, Canada
- Centre de Recherche Charles-Lemoyne, 150, Place Charles-Le Moyne Bureau 200, Longueuil, QC, J4K 0A8, Canada
| | - Cynthia Gagnon
- Groupe de Recherche Interdisciplinaire Sur Les Maladies Neuromusculaires, 2230 de L'Hôpital Cp 1200, Jonquière, QC, G7X 7X2, Canada
- Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC, J1K 2R1, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e Avenue Nord, Aile 9, Porte 6, Sherbrooke, Québec, J1H 5N4, Canada
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14
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Jensen-Marini E, Ayton D, Zalcberg J, Stirling RG. Exploring patient reported quality of life in lung cancer patients: A qualitative study of patient-reported outcome measures. Asia Pac J Clin Oncol 2024. [PMID: 38520667 DOI: 10.1111/ajco.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Lung cancer is the leading cause of cancer-related death globally and provides a major disease burden likely to substantially impact quality of life (QoL). Patient-reported outcome measures (PROMs) have been identified as effective methods of evaluating patient QoL. Existing lung cancer-specific PROMs however have uncertain utility and minimal patient involvement in their design and development. This qualitative study aimed to evaluate the patient perspective of existing PROMs and to explore their appropriateness for population-based descriptions of lung cancer-related QoL. METHODS A descriptive qualitative study was conducted consisting of semi-structured interviews with 14 patients recruited from the Victorian Lung Cancer Registry and Alfred Hospital using purposive sampling. Interviews first explored the factors most important to lung cancer patients QoL, and second, patient's perspectives on the appropriateness of existing PROMs. Thematic analysis was used to develop themes, and content analysis was conducted to determine PROM acceptability. RESULTS Five novel themes were identified by patients as being important impacts on QoL: Personal attitude toward the disease is important for coping; independence is valued; relationships with family and friends are important; relationships with treating team are meaningful; personal and public awareness of lung cancer is limited. These patient-identified impacts are poorly covered in existing lung cancer-specific PROMs. Patients welcomed and appreciated the opportunity to complete PROMs; however, they identified problems with existing PROMs relevance, tone, and formatting. CONCLUSION Existing lung cancer PROMs poorly reflect the five themes identified in this study as most important to lung cancer patients QoL. This study reaffirms the need to review existing PROMs to ensure utility and construct validity. Future PROM development must engage key patient-generated themes and evolve to reflect the changing management and therapeutic landscape.
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Affiliation(s)
- Elena Jensen-Marini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
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15
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Ziegenfuss JY, Asche SE, Dehmer SP, Reams M, Grossman ES, Solberg LI. The Impact of Text Messaging to Promote Patient Reported Outcome Measures (PROMs) Completion in Orthopedic Practice: Findings From a Randomized Controlled Study. Am J Med Qual 2024; 39:78-85. [PMID: 38403961 DOI: 10.1097/jmq.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
It is difficult to achieve high response rates to Patient Reported Outcome Measures (PROMs) surveys collected as part of clinical care. However, they are operationally and clinically important. To understand the impact of text message reminders on response rates to PROMs collected via email as part of routine care for hip or knee replacement surgery, initial nonresponders were randomized to receive a text reminder or not at 7 and 12 days, if needed. At day 7, the overall survey response rate was 63%. Model-derived estimates for survey return after this point were 51.1% (95% confidence interval [CI], 48.0%-54.2%) in the text arm compared to 34.5% (95% CI, 31.6%-37.6%) in the no text arm. The effect of text messages on response rates did not vary by subpopulations considered nor were there differences in rates of key outcomes between the 2 groups, suggesting that it did not impact any underlying response bias. Given the relative low cost of text messages, they can be an efficient means to increase response rates.
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Affiliation(s)
- Jeanette Y Ziegenfuss
- Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN
| | - Stephen E Asche
- Research and Evaluation, HealthPartners Institute, Minneapolis, MN
| | - Steven P Dehmer
- Research and Evaluation, HealthPartners Institute, Minneapolis, MN
| | - Megan Reams
- TRIA, Park Nicollet Health Services, St Louis Park Specialty Center, St Louis Park, MN
| | | | - Leif I Solberg
- Research and Evaluation, HealthPartners Institute, Minneapolis, MN
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16
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Thompson K, Lo AHY, McGlashan HL, Ownsworth T, Haslam C, Pegna A, Reutens DC. Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties. Neuropsychol Rev 2024; 34:67-97. [PMID: 36633798 DOI: 10.1007/s11065-022-09568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/21/2022] [Indexed: 01/13/2023]
Abstract
People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.
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Affiliation(s)
- Kate Thompson
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia.
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia.
| | - Ada H Y Lo
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Hannah L McGlashan
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
- Surgical Treatment and Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Catherine Haslam
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Alan Pegna
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - David C Reutens
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia
- Neurology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
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17
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Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [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: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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18
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Johnsen HM, Øgård-Repål A, Martinez SG, Fangen K, Bårdsen Aas K, Ersfjord EMI. Patients' perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in a Norwegian outpatient clinic: a qualitative study. BMC Health Serv Res 2024; 24:209. [PMID: 38360650 PMCID: PMC10870609 DOI: 10.1186/s12913-024-10659-z] [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: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telemedicine in outpatient services for people living with human immunodeficiency virus (PLHIV) was scaled up during the COVID-19 pandemic as services transitioned to remote care. Many studies have reported on the challenges and advantages of telemedicine care during the pandemic. However, there is limited research on the provision of telemedicine human immunodeficiency virus (HIV) care beyond the COVID-19 pandemic, which entails different telemedicine components and focuses on ways to improve the telemedicine experience for patients. This study aimed to explore PLHIV's perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in an outpatient clinic in Norway. The telemedicine solution included a pre-consultation questionnaire, asynchronous digital messages, and video consultation. METHODS Qualitative interviews were conducted with 12 PLHIV. The interviews were analysed using thematic analysis. RESULTS We identified four main themes that covered the participants' perceptions, needs, and preferences: (1) perceived usability, (2) maintaining confidentiality, (3) accommodating personal preferences, and (4) perceived usefulness. Some participants had difficulty logging into the telemedicine solution. Other participants suggested additional functionalities, such as picture sharing and access to test result. Telemedicine care enabled the avoidance of stigmatising clinic experiences, although a few participants reported concerns about confidentiality and data security. Accommodating personal preferences and needs in terms of the type of consultations (in-person or video) and frequency of visits was essential to the participants. With telemedicine care, participants felt more in control of their own lives, perceiving that it increased their perceived quality of life and saved them both time and money for travelling to the clinic. CONCLUSIONS Our study identified several specific needs and preferences related to the assessed technical solution and the provision of current and future telemedicine care services. Nevertheless, the telemedicine solution was perceived as a usable, flexible, and person-centred approach to HIV care, contributing to accommodating the participants' personal preferences. However, healthcare professionals need to ensure that individual requirements and preferences are consistent with evidence-based follow-up and supported by person-centred care. Thus, the practice of shared decision making is important in telemedicine care.
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Affiliation(s)
- Hege Mari Johnsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway.
| | - Anita Øgård-Repål
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Santiago Gil Martinez
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Kim Fangen
- Sørlandet Hospital, Kristiansand, Norway
| | | | - Ellen Margrete Iveland Ersfjord
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
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19
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Hasan S, Chevidikunnan MF, Khan F. Reliability and validity of the Arabic version of the modified falls efficacy scale. Disabil Rehabil 2024; 46:793-801. [PMID: 36727527 DOI: 10.1080/09638288.2023.2175045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. MATERIALS AND METHODS The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). RESULTS The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). CONCLUSION The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.
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Affiliation(s)
- Sami Hasan
- Department of occupational therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Fayaz Khan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
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20
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Areia M, Dias LP, Matos P, Figueiredo D, Neves AL, da Costa ED, Loureiro CC, Boechat JL, Reis AB, Simões P, Taborda‐Barata L, Fonseca JA, Sá‐Sousa A, Jácome C. Public involvement in chronic respiratory diseases research: A qualitative study of patients', carers' and citizens' perspectives. Health Expect 2024; 27:e13917. [PMID: 38375962 PMCID: PMC10768873 DOI: 10.1111/hex.13917] [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: 03/14/2023] [Revised: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. METHODS A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi-structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. RESULTS Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18-72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. CONCLUSION Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. PATIENT OR PUBLIC CONTRIBUTION This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network-a collaborative network of research in respiratory health. PUBLIC SUMMARY In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.
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Affiliation(s)
- Margarida Areia
- Allergy and Clinical Immunology UnitCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Liliana P. Dias
- Allergy and Clinical Immunology UnitCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Paula Matos
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health SciencesUniversity of AveiroAveiroPortugal
| | - Ana L. Neves
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
- Department of Primary Care and Public HealthImperial College LondonLondonUK
| | | | - Cláudia C. Loureiro
- Pneumology UnitHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - José L. Boechat
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of PathologyBasic and Clinical Immunology, Faculty of Medicine of the University of PortoPortoPortugal
- Allergy UnitInstituto CUF Porto e Hospital CUF PortoPortoPortugal
| | - António B. Reis
- Utopia Academy, Utopia, Innovation on Digital Media LabUniversidad Carlos III de MadridMadridSpain
| | - Pedro Simões
- CICS‐UBI Health Sciences Research Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UBIAir—Clinical and Experimental Lung Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UCSP Fundão, ACeS Cova da BeiraCovilhãPortugal
| | - Luís Taborda‐Barata
- CICS‐UBI Health Sciences Research Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UBIAir—Clinical and Experimental Lung Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- Department of ImmunoallergologyCovada Beira University Hospital Centre, CACB‐Clinical Academic Centre of BeirasCovilhãPortugal
| | - João A. Fonseca
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
- Allergy UnitInstituto CUF Porto e Hospital CUF PortoPortoPortugal
| | - Ana Sá‐Sousa
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
| | - Cristina Jácome
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
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Zhang X, Krabbe PFM. From simple to even simpler, but not too simple: a head-to-head comparison of the Better-Worse and Drop-Down methods for measuring patient health status. BMC Med Res Methodol 2023; 23:299. [PMID: 38104119 PMCID: PMC10725035 DOI: 10.1186/s12874-023-02119-9] [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: 04/14/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND We recently developed a novel, preference-based method (Better-Worse, BW) for measuring health status, expressed as a single metric value. We have since expanded it by developing the Drop-Down (DD) method. This article presents a head-to-head comparison of these two methods. We explored user feasibility, interpretability and statistics of the estimated coefficients, and distribution of the computed health-state values. METHODS We conducted a cross-sectional online survey among patients with various diseases in the USA. The BW and DD methods were applied in the two arms of the study, albeit in reverse order. In both arms, patients first performed a descriptive task (Task 1) to rate their own health status according to the 12 items (each with 4 levels) in the CS-Base health-outcome instrument. They then performed Task 2, in which they expressed preferences for health states by the two methods. We then estimated coefficients for all levels of each item using logistic regression and used these to compute values for health states. RESULTS Our total sample comprised 1,972 patients. Completion time was < 2 min for both methods. Both methods were scored as easy to perform. All DD coefficients were highly significant from the reference level (P < 0.001). For BW, however, only the second-level coefficient of "Cognition" was significantly different (P = 0.026). All DD coefficients were more precise with narrower confidence intervals than those of the BW method. CONCLUSIONS Both the BW and DD are novel methods that are easy to apply. The DD method outperformed the BW method in terms of the precision of produced coefficients. Due to its task, it is free from a specific distorting factor that was observed for the BW method.
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Affiliation(s)
- Xin Zhang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Paul F M Krabbe
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.
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van der Sterren AE, Nathan S, Rawstorne P, Yarbakhsh E, Gough C, Bowles D. Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review. Health Expect 2023; 26:2151-2163. [PMID: 37515528 PMCID: PMC10632652 DOI: 10.1111/hex.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date. METHODS PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage. RESULTS Thirty measures-23 satisfaction and 7 experience-were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs. CONCLUSION Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development. PATIENT OR PUBLIC CONTRIBUTION This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.
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Affiliation(s)
- Anke E. van der Sterren
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Sally Nathan
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Patrick Rawstorne
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Elisabeth Yarbakhsh
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy (CAHMA)CanberraAustralian Capital TerritoryAustralia
| | - Devin Bowles
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
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23
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Solberg LI, Ziegenfuss JY, Rivard RL, Norton CK, Whitebird RR, Elwyn G, Swiontkowski M. Is There Room for Individual Patient-Specified Preferences in the Patient-Reported Outcome Measurement Revolution? J Patient Cent Res Rev 2023; 10:210-218. [PMID: 38046995 PMCID: PMC10688914 DOI: 10.17294/2330-0698.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose The study aim was to test the feasibility of collecting qualitative patient-preferred outcomes or goals and the degree of their attainment as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. Methods Patients of a large Midwestern medical group scheduled to have total replacement of their knee joint have been asked to complete a PROMs survey preoperatively and at 3 and 12 months after surgery since 2014. In March 2020, an open-ended question about their most important preferred outcome was added to the existing questionnaire. The responses for all 3 time periods from the first 6 months of this addition were summarized quantitatively and analyzed by 2 reviewers. Results During that 6-month period, 1481 people completed the main survey while 1463 (98.8%) also completed the open-ended question. At baseline, 90.8% of the 590 baseline respondents identified a preferred outcome. If multiple-choice categories had been used, 82.7% of the responses would have lost some or a large amount of their preferred goals' meaning. Of the 144 who completed surveys at both baseline and 3 months, 86.1% reported another outcome in addition to pain relief, while 54.2% reported "Complete or Mostly" achieving their self-identified preferred outcome. Conclusions Most people who have joint replacement surgery and respond to a quantitative PROMs survey are willing to report on their other preferred outcomes as well. Adding an open-ended question to PROMs surveys may increase clinician focus on addressing outcomes important to each patient.
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Vecoso LVZ, Silva MT, Livinalli A, Barreto JOM, Galvao TF. Patients' perspectives on the relevance of biosimilars' outcomes in oncology: qualitative study with nominal group technique. Support Care Cancer 2023; 31:722. [PMID: 38008777 DOI: 10.1007/s00520-023-08184-6] [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: 06/29/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE We aimed to rate the importance of outcomes from a systematic review about biosimilars in oncology from patients' perspective. METHODS This is a qualitative research with nominal group technique. Patients with cancer were selected by convenience sampling and invited for two mediated virtual meetings in 2022. Twelve outcomes from a systematic review on biosimilars for oncology developed following a protocol were explained in plain language to participants who classified them as critical, important, or not important according to the Grading of Recommendations Assessment, Development and Evaluation approach. We employed Iramuteq software for lexical categorization of the meeting transcripts, and content analysis for interpretation. RESULTS Five women participated (three had metastatic cancer, one non-metastatic, one recurrent). Six outcomes were classified as critical: duration of response, progression-free survival, pathological complete response, overall survival, severe adverse events, and quality of life; three as important: mortality, event-free survival, and objective response; and three as non-important: neutralizing anti-drug antibody, any adverse event, and non-neutralizing anti-drug antibody. Duration of response, pathological complete response, severe adverse events, and quality of life were considered secondary in the review protocol, but critical by the patients. The main themes influencing the importance classification were related to the disease (progression and control) and treatment (recognition and healthcare setting). CONCLUSION Patients rated most outcomes as critical or important, some of them previously regarded as secondary by the researchers, which reinforces the need to include stakeholders' perspectives in oncology research. Aspects of the disease progression and treatment effects influenced participants' judgment on outcomes' relevance.
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Bluett-Duncan M, Astill D, Charbak R, Clayton-Smith J, Cole S, Cook PA, Cozens J, Keely K, Morris J, Mukherjee R, Murphy E, Turnpenny P, Williams J, Wood AG, Yates LM, Bromley RL. Neurodevelopmental outcomes in children and adults with Fetal Valproate Spectrum Disorder: A contribution from the ConcePTION project. Neurotoxicol Teratol 2023; 100:107292. [PMID: 37666366 DOI: 10.1016/j.ntt.2023.107292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
AIM To describe the neurodevelopmental phenotype of older children and adults with a diagnosis of Fetal Valproate Spectrum Disorder (FVSD). METHODS In this cross-sectional study, 90 caregivers were recruited and completed a series of questionnaires regarding the neurodevelopmental outcomes of 146 individuals aged 7-37 years (M = 18.1), including individuals with a formal diagnosis of FVSD (n = 99), individuals exposed to Valproate but without an FVSD diagnosis (n = 24), and individuals not exposed to Valproate (N = 23). The mean dose of valproate exposure for individuals with an FVSD diagnosis was 1470 mg/day. RESULTS Individuals with a diagnosis of FVSD showed significantly higher levels of moderate (43.4%) and severe (14.4%) cognitive impairment than other groups (p = 0.003), high levels of required formal educational support (77.6%), and poorer academic competence than individuals not exposed to Valproate (p = 0.001). Overall psychosocial problems (p = 0.02), internalising problems (p = 0.05) and attention problems (p = 0.001), but not externalising problems, were elevated in individuals with a diagnosis of FVSD. Rates of neurodevelopmental disorders, particularly autistic spectrum disorders (62.9%) and sensory problems (80.6%) are particularly central to the FVSD phenotype. There was no evidence of a statistical dose-dependent effect, possibly due to the high mean dose of exposure having a uniformly negative impact across the sample. Individuals with FVSD had required a significant number of health and child development services. INTERPRETATION Children and young adults with a diagnosis of FVSD are at an increased risk of a range of altered neurodevelopmental outcomes, highlighting the need for a multidisciplinary approach to clinical management across the lifespan.
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Affiliation(s)
- M Bluett-Duncan
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK.
| | - D Astill
- Foetal Anti-Convulsant Syndrome New Zealand, Aukland, New Zealand
| | - R Charbak
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK
| | - J Clayton-Smith
- Division of Evolution, Systems and Genomics, University of Manchester, UK
| | - S Cole
- Pharma Consent, London, UK
| | - P A Cook
- School of Health and Society, University of Salford, UK
| | - J Cozens
- Organisation for Anti-Convulsant Syndrome, UK
| | - K Keely
- Organisation for Anti-Convulsant Syndrome, Ireland
| | - J Morris
- Foetal Anti-Convulsant Syndrome New Zealand, Aukland, New Zealand
| | - R Mukherjee
- Department of Health and Social Science, University of Salford, Allerton Building, Salford, England, UK
| | - E Murphy
- Independent Fetal Anti-Convulsant Trust, Preston, UK
| | - P Turnpenny
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Williams
- Independent Fetal Anti-Convulsant Trust, Preston, UK
| | - A G Wood
- Clinical Sciences, Murdoch Children's Research Institute, & School of Psychology, Deakin University, Melbourne, Australia; Institute of Health and Neurodevelopment, Aston University, UK
| | - L M Yates
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK; KRISP, University of KwaZulu-Natal, South Africa
| | - R L Bromley
- Division of Neuroscience, School of Biological Sciences, The University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Smit Y, Metsemakers SJJPM, Janssen JJWM, Posthuma EFM, Walraven I, Hermens RPMG, Blijlevens NMA. Measuring chronic myeloid leukaemia TKI-related toxic effects in the real world: a systematic review and critical assessment of content validity of patient-reported outcome measures. Lancet Haematol 2023; 10:e849-e859. [PMID: 37604177 DOI: 10.1016/s2352-3026(23)00173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/23/2023]
Abstract
Insight into real-world treatment-related toxic effects reported by patients has the potential to improve care, benchmark trials, and fill knowledge gaps, especially in patients with chronic myeloid leukaemia, which is treated in the majority of patients continually with tyrosine-kinase inhibitors (TKIs). The aim of our systematic review was to investigate the content validity of instruments that elicit TKI-related toxic effects reported by patients with chronic myeloid leukaemia in the real world. We searched PubMed and Embase from Jan 1, 2017 to Oct 21, 2022. Studies on instruments used in or developed for patients with chronic myeloid leukaemia that assess a patient's symptoms were eligible. Content validity was assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN): none of the six identified instruments were rated as sufficient. Five instruments (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire for chronic myeloid leukaemia with 24 items [EORTC QLQ-CML24], EORTC symptom set, Functional Assessment of Cancer Therapy-Leukaemia [FACT-LEU], haematological malignancies patient-reported outcomes [HM-PRO], and MD Anderson Symptom Inventory for chronic myeloid leukaemia [MDASI-CML]) were rated as inconsistent due to not being evaluated by professionals post-development, having very few patients with chronic myeloid leukaemia involved, or missing key symptoms. Moderate-quality to very low-quality evidence underpinned these ratings. The two EORTC instruments were the only ones not to miss key toxic effects (eg, muscle cramps). However, their relevance was rated as inconsistent: the QLQ-CML24 includes questions on health-related quality-of-life, whereas the symptom set includes items sourced from solid cancer treatments. This Review shows the need for an instrument with sufficient content validity to measure toxic effects from TKI treatment in patients with chronic myeloid leukaemia. Until then, stakeholders can make an informed choice from currently used instruments with our assessment.
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Affiliation(s)
- Yolba Smit
- Department of Haematology, Radboud University Medical Center, Nijmegen, Netherlands.
| | | | - Jeroen J W M Janssen
- Department of Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Netherlands; Department of Haematology, Leiden University Medical Center, Leiden, Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Trevisan CLM, Carraro A, Baldari GLA. Treatment Satisfaction, Efficacy, and Tolerability of Low-Dose Diclofenac Epolamine Soft Capsules in Acute, Mild, or Moderate Musculoskeletal Pain: A Prospective Open-Label, Single-Arm Interventional Study. Pain Ther 2023; 12:1149-1163. [PMID: 37314686 PMCID: PMC10266308 DOI: 10.1007/s40122-023-00531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) for acute musculoskeletal pain should be at the lowest effective dosage and for the shortest duration to minimize potential adverse effects. This study evaluated treatment satisfaction, effectiveness, and tolerability of a low-dose diclofenac epolamine 12.5-mg soft capsule formulation (DHEP 12.5-mg capsules) using patient-reported outcome measures in a real-life setting over a short period (3 days) in subjects with mild-to-moderate acute musculoskeletal pain. METHODS A prospective, open-label, phase IV clinical study in adult outpatients at hospital clinic departments/general practitioner's clinics at eight sites in Italy. The primary efficacy variable was the degree of satisfaction with treatment at 72 ± 7 h after initiation of treatment, assessed using the Overall Satisfaction Question of the Pain Treatment Satisfaction Scale (PTSS) and described by classic descriptive statistics. Secondary objectives were to evaluate the analgesic effect after the first administration and over time; the time to and satisfaction with the onset of pain relief, amount of and duration of pain relief; pain intensity differences over time; and safety and tolerability. The investigator's satisfaction with the treatment was also assessed. Subjects initially took 1-2 capsules of the study treatment and then one or two soft capsules every 4-6 h according to their needs. Not more than six soft capsules were to be taken in any 24-h period. RESULTS A total of 182 subjects (mean age, 56.2 years; 54.4% female) took ≥ 1 dose of DHEP capsule and were included in the full analysis set. The most common musculoskeletal conditions were arthralgia (39.0%) and low back pain (23.1%). All subjects completed the study, and 165/182 (90.7%, 95% CI 0.86, 0.95) were satisfied or very satisfied with the treatment at 72 ± 7 h after the first dose (primary efficacy variable). Similar percentages were recorded for treatment satisfaction concerning other efficacy parameters. The onset of the analgesic effect was rapid, with complete pain relief reached after a mean of 49.45 min. Investigators rated their overall treatment satisfaction as 92.9%. Treatment was well tolerated. CONCLUSIONS The low-dose (12.5 or 25 mg) oral diclofenac epolamine soft capsules formulation exerted rapid, effective, and safe analgesic activity in patients with mild-to-moderate musculoskeletal pain, with subjects' overall satisfaction with treatment more than 90%. TRIAL REGISTRATION EudraCT Number: 2018-004886-15 (Study 18I-Fsg08). Registered 04/09/2018.
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Affiliation(s)
- Carlo L M Trevisan
- Orthopedic Department, Ospedale Bolognini Seriate ASST Bergamo Est, Seriate, Italy.
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Taimeh D, Riordain RN, Fedele S, Leeson R. Healthcare priorities in patients with chronic facial pain of temporomandibular disorders. Oral Dis 2023; 29:2878-2887. [PMID: 36565449 DOI: 10.1111/odi.14483] [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: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the experiences of patients with temporomandibular disorders (TMDs) with the National Health Service and to discover their healthcare priorities when seeking treatment. METHODS Semi-structured interviews were used. They were directed using a topic guide covering subjects such as initial visits in primary care, referrals to secondary care, and the effect on symptoms. The discussions were audiotaped and transcribed verbatim. Thematic analysis was utilised to analyse the data. RESULTS In total, 15 participants took part in three focus groups. Six themes were identified: "access to appropriate care", "organised and coordinated care", "receiving a diagnosis and enough information", "interaction with the clinical staff", "treatment strategies and having an 'action plan'" and "support and social networks". CONCLUSIONS The participants gave accounts of the difficulties encountered in healthcare in general terms and specific to TMD. Most notable was the struggle to access appropriate care, receive a diagnosis and be understood. Our findings suggest that delays in delivering appointments with people of expertise may have caused the worsening of symptoms. However, when a pleasant experience was encountered, access to care was fast, the clinician was understanding and communication with the clinical team was good. These provided positive experiences and were appreciated by the patients.
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Affiliation(s)
- Dina Taimeh
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan
| | - Richeal Ni Riordain
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Cork University Dental School and Hospital, Cork, Ireland
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel Leeson
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
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Lee VV, Lau NY, Blasiak A, Siah KTH, Ho D. Involving patients in the process: Development of a constipation patient-reported outcome measure for symptoms and quality of life. Comput Struct Biotechnol J 2023; 22:41-49. [PMID: 37822352 PMCID: PMC10563011 DOI: 10.1016/j.csbj.2023.09.034] [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] [Received: 04/21/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
Objective Patient-reported outcome measures (PROMs) are useful standardized tools to measure current patient health status and well-being. While there are existing constipation-related PROMs, the majority of PROMs were not developed with adequate patient involvement and few examined content validity. Accordingly, the current study aimed to develop a constipation PROM with multiple phases of patient and clinician involvement. Methods To generate PROM items, 15 patients with chronic constipation (age range =28-79 years, 10 females) underwent a qualitative interview exploring their experiences with chronic constipation. Following that, eight clinical experts completed the content validity index (CVI) ratings of all the items generated to assess content validity. Based on results of the content validity assessment, relevant items were maintained and 12 participants with chronic constipation were re-interviewed to obtain feedback about comprehensibility, comprehensiveness and relevance. Results Six themes and 25 sub-themes emerged from the qualitative interview, and an initial list of 33 symptom items and 18 quality of life (QoL) items were generated. Based on the CVIs calculated, 11 symptom items and nine QoL items were maintained with the scale-content validity index indicating excellent content validity. Overall, participants indicated the PROM to be relevant, comprehensive and easy to understand however, minor amendments were made to improve the three qualities of interest. Conclusion The current study developed a constipation PROM that measures both symptom severity and constipation-related QoL, with supporting evidence for relevance, comprehensiveness and comprehensibility. Further prioritization should be given to validating and exploring new digital modalities of PROM administration.
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Affiliation(s)
- V Vien Lee
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ni Yin Lau
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Bia-Echo Asia Centre for Reproductivity Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Delnoij DMJ, Derks M, Koolen L, Shekary S, Suitela J. Using Patient Blogs on Social Media to Assess the Content Validity of Patient-Reported Outcome Measures: Qualitative Analysis of Patient-Written Blogs. JMIR Form Res 2023; 7:e43210. [PMID: 37505797 PMCID: PMC10422175 DOI: 10.2196/43210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/02/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are questionnaires that measure patient outcomes related to quality of life, health, and functioning, and are increasingly used to assess important outcomes from the patient's perspective. For PROMs to contribute to better health and better care, it is vital that their content validity be adequate. This requires patient involvement in various steps of PROM development. PROM developers not only recognize the benefits of patient involvement but also report difficulties in recruiting patients and experience patient involvement as time-consuming, logistically challenging, and expensive. OBJECTIVE This study seeks to explore different strategies for disclosing the experiential knowledge of patients, namely through analyzing patient stories on the web and social media. The research questions are as follows: (1) how do bloggers living with a disease experience their health-related quality of life? (2) How are these experiences reflected in the domains and items of PROMs related to their disease? METHODS First, a qualitative analysis of blogs written by patients was performed. Second, subthemes and underlying codes resulting from this qualitative analysis were systematically compared with the domains and items in PROMs for the respective diseases that the bloggers write about. Blogs were identified via the Google search engine between December 2019 and May 2021. RESULTS Bloggers describe a wide range of experiences regarding their physical functioning and health; mental well-being; social network and support; daily life, education, work, and leisure; coping; and self-management. Bloggers also write about their positive and negative experiences with health care delivery, the organization of health care, and health care professionals. In general, patients' experiences as described in blogs were reflected in the domains and items of the PROMs related to their disease. However, except for diabetes mellitus, in all the sets of PROMs, potentially missing topics could be identified. Similarly, with the exception of Parkinson disease, all PROMs address issues that patients did not write about in their blogs and that might therefore be redundant. CONCLUSIONS Web-based patient stories in the form of blogs reveal how people living with a certain disease experience their health-related quality of life. These stories enable analyses of patients' experiences that can be used to assess the content validity of PROMs. This can be a useful step for researchers who are looking for sets of measuring instruments that match their purposes.
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Affiliation(s)
- Diana M J Delnoij
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- National Health Care Institute (Zorginstituut Nederland), Diemen, Netherlands
| | - Meggie Derks
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Laura Koolen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Shuka Shekary
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jozua Suitela
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Kidanemariam M, Pieterse AH, van Staalduinen DJ, Bos WJW, Stiggelbout AM. Does value-based healthcare support patient-centred care? A scoping review of the evidence. BMJ Open 2023; 13:e070193. [PMID: 37429675 DOI: 10.1136/bmjopen-2022-070193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Standardisation of outcome measures is integral to value-based healthcare (VBHC), which may conflict with patient-centred care, focusing on personalisation. OBJECTIVES We aimed to provide an overview of measures used to assess the effect of VBHC implementation and to examine to what extent the evidence indicates that VBHC supports patient-centred care. DESIGN A scoping review guided by the Joanna Briggs Institute methodology. SOURCES OF EVIDENCE We searched the following databases on 18 February 2021: Cochrane Library, EMBASE, MEDLINE and Web of Science. ELIGIBILITY CRITERIA We included empirical papers assessing the effect of the implementation of VBHC, published after introduction of VBHC in 2006. DATA EXTRACTION AND SYNTHESIS Two independent reviewers double-screened papers and data were extracted by one reviewer and checked by the other. We classified the study measures used in included papers into six categories: process indicator, cost measure, clinical outcome, patient-reported outcome, patient-reported experience or clinician-reported experience. We then assessed the patient-centredness of the study measures used. RESULTS We included 39 studies using 94 unique study measures. The most frequently used study measures (n=72) were process indicators, cost measures and clinical outcomes, which rarely were patient-centred. The less frequently used (n=20) patient-reported outcome and experience measures often measured a dimension of patient-centred care. CONCLUSION Our study shows that the evidence on VBHC supporting patient-centred care is limited, exposing a knowledge gap in VBHC research. The most frequently used study measures in VBHC research are not patient-centred. The major focus seems to be on measures of quality of care defined from a provider, institution or payer perspective.
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Affiliation(s)
- Martha Kidanemariam
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorine J van Staalduinen
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Public Administration, Leiden University, The Hague, The Netherlands
| | - Willem Jan W Bos
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Uimonen M, Kuitunen I, Pakarinen O, Vaajala M, Liukkonen R, Tukiainen H, Ponkilainen V. Quality of surgical patient-reported outcome measure validation studies is often deficient: a systematic review. J Clin Epidemiol 2023; 158:27-33. [PMID: 37004794 DOI: 10.1016/j.jclinepi.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES To examine the methodological basis behind the conclusions of patient-reported outcome measure (PROM) validation studies. STUDY DESIGN AND SETTING A systematic review was performed on surgical studies evaluating the measurement properties of a PROM between June 1 and December 31, 2021. The quality of the validity subfield evaluation in the studies was assessed according to the consensus-based standards for the selection of health measurement instruments checklist. Nine validity subfields were assessed. RESULTS The median sample size of the 87 included studies was 125 (interquartile range: 99-226), and 22 of the studies (25%) had an insufficient sample size according to the consensus-based standards for the selection of health measurement instruments checklist. For the nine validity subfields, the mean number of correctly assessed subfields was 3.6 (standard deviation: 1.5). In 68 of the studies (78%), the conclusion determined the PROM to be valid. In these studies, the mean number of evaluated validity subfields was 3.8 (standard deviation: 1.4). None of the studies reported that the PROM was not valid. CONCLUSION The empirical basis of the conclusions drawn in studies investigating the measurement properties of a PROM is often deficient. PROM studies were often performed with insufficient sample sizes and focused on only a few validity subfields, calling into question the deterministic conclusions that a PROM is valid.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland; Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Ilari Kuitunen
- University of Eastern Finland, School of Medicine, Yliopistonranta 1, PL 1627, 70211 Kuopio, Finland; Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland
| | - Oskari Pakarinen
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Matias Vaajala
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Rasmus Liukkonen
- Tampere University, Faculty of Medicine and Health Technology, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Hannes Tukiainen
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
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Morales-Ariza V, Loaiza-Aldeán Y, de Miguel M, Peña-Navarro M, Martínez-Silva O, González-Tallada A, Manrique-Muñoz S, de Nadal M. Validation and cross-cultural adaptation of the postoperative quality of recovery 15 (QoR-15) questionnaire for Spanish-speaking patients: A prospective cohort study. Am J Surg 2023; 225:740-747. [PMID: 36414472 DOI: 10.1016/j.amjsurg.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postoperative QoR-15 questionnaire may improve the detection of postoperative complications on an early basis and contribute to optimize treatment and recovery. No validated Spanish QoR-15 questionnaire has been available to date. METHODS The Spanish QoR-15 questionnaire (QoR-15E), carried out by official bilingual translators, was administered to 242 adult patients undergoing elective surgery before and 24 h after surgery. Patients were asked about their perceived quality of general recovery using a visual analogue scale (VAS). A random subgroup of 36 patients completed a third questionnaire 30-60 min after having completed the first one, and under the same conditions. RESULTS The Pearson correlation coefficient between QoR-15E and the VAS score was 0.759. Cronbach's alpha was 0.856 in the postoperative period. Reliability by the split-half method was 0.781. Test-retest correlation coefficient was 0.998. Cohen's d was 0.94. The mean time to complete the preoperative questionnaire was 2.9 ± 0.5 min. CONCLUSIONS The QoR-15E is valid and reliable for assessing postoperative quality of recovery in Spanish-speaking patients, with psychometric and interpretative features similar to those of the original instrument.
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Affiliation(s)
- Victor Morales-Ariza
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Yuri Loaiza-Aldeán
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Marcos de Miguel
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mireia Peña-Navarro
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Olga Martínez-Silva
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anna González-Tallada
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Susana Manrique-Muñoz
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Maternal and foetal medicine Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Miriam de Nadal
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Neurotraumatology and neurosurgery Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Knight E, Schifferdecker KE, Eakin GS, Reeve BB. Selecting patient-reported outcome measures of health-related quality of life in adult rheumatology: quality and breadth of coverage. Rheumatol Int 2023; 43:627-638. [PMID: 36125521 DOI: 10.1007/s00296-022-05200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
Patient-centered research should assess outcomes important to patients and include patient-reported outcome measures (PROMs) to assess health-related quality of life (HRQOL) domains. Using a well-known HRQOL framework (World Health Organization QOL, or WHOQOL), we reviewed established PROMs used with adults with different types of arthritis to evaluate their HRQOL domain coverage and psychometric evidence to help PROM users select measures and determine whether other measures should be validated and/or developed. Nineteen PROMs and 92 corresponding articles were reviewed to determine which HRQOL domains were assessed. To support a streamlined but rigorous review, we used a rating system based on criteria established in part through existing rubrics (e.g., OMERACT COSMIN). Psychometric properties were rated on a scale from 1 to 18, where 18 was strongest. We examined the intersection between level of domain coverage and extent of psychometric support. Measures most commonly assessed physical health and level of independence, while fewer assessed social relations, environment, and psychological health. No measures assessed spirituality and religion, which may be relevant depending on intended use. PROMs with higher psychometric evidence tended to assess a broader range of HRQOL domains. Rubric scores ranged from 3 to 16, with an average of 9.3. Prominent and psychometrically sound PROMs are available that cover many of the WHOQOL domains. While gaps exist in the domain of spirituality, future work should focus on refining optimal use of existing PROMs relevant for arthritis versus developing new measures. We provide guidance on selecting PROMs, to that end.
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Affiliation(s)
- Erin Knight
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, WTRB Level 5, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Karen E Schifferdecker
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, WTRB Level 5, One Medical Center Drive, Lebanon, NH, 03756, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Samuel V, Arora R, Virk P. Improving Reporting on Qualitative Methods Used in the Development and Validation of Patient-Reported Outcome Measures for Mental Health Concerns. J Psychosoc Nurs Ment Health Serv 2023; 61:40-44. [PMID: 36099482 DOI: 10.3928/02793695-20220902-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Qualitative methodologies are recommended in the development and evaluation of psychological instruments. However, reporting on qualitative methods in instrument development studies remains variable and often insufficient to support claims surrounding content validity. In the current article, we present a commentary discussing the critical role qualitative inquiry plays in the development of patient-reported outcome measures. We outline the current state of reporting in qualitative instrument development and evaluation studies with a focus on mental health literature and highlight the clinical relevance of this topic for health care professionals. Despite challenges, we express confidence in the potential value of substantively engaging with qualitative methods and comprehensive reporting and summarize recommendations to this effect based on the current literature. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 40-44.].
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Roldán-Merino JF, Tomás-Jiménez M, Schröder A, Lundqvist LO, Puig-Llobet M, Moreno-Poyato AR, Domínguez del Campo M, Sanchez-Balcells S, Lluch-Canut MT. Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4043. [PMID: 36901056 PMCID: PMC10002304 DOI: 10.3390/ijerph20054043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.
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Affiliation(s)
- Juan Francisco Roldán-Merino
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
| | - Manuel Tomás-Jiménez
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Patient Safety Research Group, Hospital Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
- Department of Nursing, Faculty of Health Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Montserrat Puig-Llobet
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antonio R. Moreno-Poyato
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Domínguez del Campo
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Etiopatogenia I Tractament Dels Trastorns Mental Severs (MERITT), Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Maria Teresa Lluch-Canut
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
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Gould DJ, Glanville-Hearst M, Bunzli S, Choong PFM, Dowsey MM. Research Buddy partnership in a MD-PhD program: lessons learned. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:4. [PMID: 36803954 PMCID: PMC9938357 DOI: 10.1186/s40900-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND AIMS There is increasing recognition of the importance of patient involvement in research. In recent years, there has also been growing interest in patient partnerships with doctoral studies students. However, it can be difficult to know where to start and how to go about such involvement activities. The purpose of this perspective piece was to share experiential insight of the experience of a patient involvement program such that others can learn from this experience. BODY: This is a co-authored perspective piece centred on the experience of MGH, a patient who has had hip replacement surgery, and DG, a medical student completing a PhD, participating in a Research Buddy partnership over the course of over 3 years. The context in which this partnership took place was also described to facilitate comparison with readers' own circumstances and contexts. DG and MGH met regularly to discuss, and work together on, various aspects of DG's PhD research project. Reflexive thematic analysis was conducted on reflections from DG and MGH regarding their experience in the Research Buddy program to synthesise nine lessons which were then corroborated with reference to published literature on patient involvement in research. These lessons were: learn from experience; tailor the program; get involved early; embrace uniqueness; meet regularly; build rapport; ensure mutual benefit; broad involvement; regularly reflect and review. CONCLUSIONS In this perspective piece, a patient and a medical student completing a PhD reflected upon their experience co-designing a Research Buddy partnership within a patient involvement program. A series of nine lessons was identified and presented to inform readers seeking to develop or enhance their own patient involvement programs. Researcher-patient rapport is foundational to all other aspects of the patient's involvement.
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Affiliation(s)
- Daniel J Gould
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
| | - Marion Glanville-Hearst
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, QLD, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Peter F M Choong
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
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Cleland J, Hutchinson C, McBain C, Khadka J, Milte R, Cameron I, Ratcliffe J. From the ground up: assessing the face validity of the Quality of Life – Aged Care Consumers (QOL-ACC) measure with older Australians. QUALITY IN AGEING AND OLDER ADULTS 2023. [DOI: 10.1108/qaoa-07-2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Purpose
This paper aims to assess the face validity to inform content validity of the Quality of Life – Aged Care Consumers (QOL-ACC), a new measure for quality assessment and economic evaluation in aged care.
Design/methodology/approach
Semi-structured interviews were conducted with older adults (66–100 years) receiving aged care services at home (n = 31) and in residential care (n = 28). Participants provided feedback on draft items to take forward to the next stage of psychometric assessment. Items were removed according to several decision criteria: ambiguity, sensitive wording, not easy to answer and/or least preferred by participants.
Findings
The initial candidate set was reduced from 34 items to 15 items to include in the next stage of the QOL-ACC development alongside the preferred response category. The reduced set reflected the views of older adults, increasing the measure’s acceptability, reliability and relevance.
Originality/value
Quality of life is a key person-centred quality indicator recommended by the recent Royal Commission into Aged Care Quality and Safety. Responding to this policy reform objective, this study documents a key stage in the development of the QOL-ACC measure, a new measure designed to assess aged care specific quality of life.
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Bavbek S, Ozyigit LP, Baiardini I, Braido F, Roizen G, Jerschow E. Placebo, Nocebo, and Patient-Reported Outcome Measures in Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:371-379. [PMID: 36521832 DOI: 10.1016/j.jaip.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sevim Bavbek
- Division of Allergy and Clinical of Immunology, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
| | - Leyla Pur Ozyigit
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ilaria Baiardini
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Fulvio Braido
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Gigia Roizen
- Department of Immunology, Clinica Alemana De Santiago, Santiago, Chile
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Findley A, Sharma G, Bentley S, Arbuckle R, Patalano F, Naujoks C, Kommineni J, Tyagi N, Lehane A, Wolffsohn JS, Chiva-Razavi S. Comparison of Literature Review, Social Media Listening, and Qualitative Interview Research Methods in Generating Patient-Reported Symptom and Functional Impact Concepts of Presbyopia. Ophthalmol Ther 2023; 12:501-516. [PMID: 36502495 PMCID: PMC9834465 DOI: 10.1007/s40123-022-00620-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION To compare the insights obtained about the experience of individuals with presbyopia (age-related impaired near vision) across three different sources of qualitative data: a structured targeted literature review, a social media listening (SML) review, and qualitative concept elicitation (CE) interviews with individuals with presbyopia and healthcare professionals (HCPs). The number of concepts identified, depth of data, cost and time implications, and value of the patient insights generated were explored and compared for each method. METHODS Keyword searches in bibliographic databases and review of abstracts identified 120 relevant publications; in-depth targeted literature review of the qualitative studies identified key symptoms/functioning concepts. SML was conducted using publicly accessible social media sources with focus on ophthalmologic diseases using a pre-defined search string. Relevant posts from individuals with presbyopia (n = 270) were analysed and key concepts identified. Semi-structured CE interviews were conducted with individuals with presbyopia (US n = 30, Germany n = 10, France n = 10), and HCPs (US = 3, France n = 2, Germany n = 1, Japan n = 1) who were experienced in treating presbyopia. Verbatim transcripts were coded using thematic analysis. A conceptual model summarised concepts identified across sources RESULTS: Out of the total of 158 concepts identified across the three sources, qualitative CE interviews yielded the highest number of concepts (n = 151/158, 96%), with SML yielding a third of the concepts (n = 51/158, 32%) and the literature review yielding the fewest concepts (n = 33/158, 21%). Qualitative CE interviews provided greater depth of data than SML and literature reviews. SML and literature reviews were less costly and quicker to run than qualitative CE interviews and also were less burdensome for participants. CONCLUSION Qualitative CE interviews are considered the gold standard in providing greater depth of understanding of the patient experience, and more robust data. However, research requirements, budget, and available time should be considered when choosing the most appropriate research method. More time and cost-effective SML and literature review methods can be used to supplement qualitative CE interview data and provide early identification of measurement concepts. More research and regulatory guidance into less traditional qualitative methods, however, are needed to increase the value of SML and literature review data.
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Affiliation(s)
- Amy Findley
- Adelphi Values Patient-Centered Outcomes, Bollington, Cheshire, UK.
| | - Garima Sharma
- Novartis Business Services (NBS) CONEXTS, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Sarah Bentley
- Adelphi Values Patient-Centered Outcomes, Bollington, Cheshire, UK
| | - Rob Arbuckle
- Adelphi Values Patient-Centered Outcomes, Bollington, Cheshire, UK
| | | | | | - Jyothi Kommineni
- Novartis Business Services (NBS) CONEXTS, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Nishith Tyagi
- Novartis Business Services (NBS) CONEXTS, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Asha Lehane
- Adelphi Values Patient-Centered Outcomes, Bollington, Cheshire, UK
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Modanloo S, Correll Q, Correll R, Major N, Quinlan M, Reszel J, Wilding J, Lin Zhou Z, Franck LS, Harrison D. Identifying research priorities with children, youth, and families: A scoping review. J Child Health Care 2023:13674935231151748. [PMID: 36647285 DOI: 10.1177/13674935231151748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Increased patient advocacy has resulted in a shift toward more active patient engagement in the research. A scoping review was conducted to explore the literature on healthcare research priority settings wherein children, youths, or their families were involved in the priority-setting process. Six databases including MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Global Health and the James Lind Alliance website were searched up until September 2019. All primary studies involving children (<18 years of age) or families in developing research priorities in health care were included. All retrieved references were uploaded into Covidence, and two independent reviewers screened the search results. Descriptive thematic analysis was used to identify common themes. A total of 30 studies with 4247 participants were included. Less than half of the participants (n = 1237, (33%) were pediatric patients and their families. A total of 455 research priorities were identified. Three common themes emerged: (i) quality of care delivery, (ii) self-efficacy in health behaviors, and (iii) community engagement in care. This scoping review revealed priority research health topics from the perspectives of children, youths, or their families. The findings may be used as a foundation for future research to improve the health outcomes of children, youths, or their families according to their identified priorities.
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Affiliation(s)
- Shokoufeh Modanloo
- Arthur Labatt School of Nursing, Faculty of Health Sciences, 70383Western University, London, ON, Canada
| | - Quinn Correll
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | - Rhonda Correll
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Michelle Quinlan
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Jessica Reszel
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Jodi Wilding
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Zhi Lin Zhou
- Children's Hospital of Eastern Ontario 274065(CHEO) Research Institute, Ottawa, ON, Canada
| | - Linda S Franck
- School of Nursing, 8783University of California, San Francisco, CA, USA
| | - Denise Harrison
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Ritunnano R, Papola D, Broome M, Nelson B. Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions. Epidemiol Psychiatr Sci 2023; 32:e5. [PMID: 36645112 PMCID: PMC9879858 DOI: 10.1017/s2045796022000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This editorial reflects on current methodological trends in translational research in mental health. It aims to build a bridge between two fields that are frequently siloed off from each other: interventional research and phenomenologically informed research. Recent years have witnessed a revival of phenomenological approaches in mental health, often - but not only - as a means of connecting the subjective character of experience with neurobiological explanatory accounts of illness. Rich phenomenological knowledge accrued in schizophrenia, and wider psychosis research, has opened up new opportunities for improving prediction, early detection, diagnosis, prognostic stratification, treatment and ethics of care. Novel qualitative studies of delusions and hallucinations have challenged longstanding assumptions about their nature and meaning, uncovering highly complex subjective dimensions that are not adequately captured by quantitative methodologies. Interdisciplinary and participatory research efforts, informed by phenomenological insights, have prompted revisions of pre-established narratives of mental disorder dominated by a dysfunction framework and by researcher-centric outcome measures. Despite these recent advances, there has been relatively little effort to integrate and translate phenomenological insights across applied clinical research, with the goal of producing more meaningful, patient-valued results. It is our contention that phenomenological psychopathology - as the basic science of psychiatry - represents an important methodology for advancing evidence-based practices in mental health, and ultimately improving real-world outcomes. Setting this project into motion requires a greater emphasis on subjectivity and the structures of experience, more attention to the quality and patient-centredness of outcome measures, and the identification of treatment targets that matter most to patients.
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Affiliation(s)
- R. Ritunnano
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Author for correspondence: R. Ritunnano, E-mail:
| | - D. Papola
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - M.R. Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - B. Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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van Gorp M, Grootenhuis MA, Darlington AS, Wakeling S, Jenney M, Merks JHM, Hjalgrim LL, Adams M. Patient Reported Outcomes and Measures in Children with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020420. [PMID: 36672371 PMCID: PMC9856469 DOI: 10.3390/cancers15020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
In addition to optimising survival of children with rhabdomyosarcoma (RMS), more attention is now focused on improving their quality of life (QOL) and reducing symptoms during treatment, palliative care or into long-term survivorship. QOL and ongoing symptoms related to the disease and its treatment are outcomes that should ideally be patient-reported (patient-reported outcomes, PROs) and can be assessed using patient-reported outcome measures (PROMS). This commentary aims to encourage PRO and PROM use in RMS by informing professionals in the field of available PROMs for utilisation in paediatric RMS and provide considerations for future use in research and clinical practice. Despite the importance of using PROMs in research and practice, PROMs have been reported scarcely in paediatric RMS literature so far. Available literature suggests lower QOL of children with RMS compared to general populations and occurrence of disease-specific symptoms, but a lack of an RMS-specific PROM. Ongoing developments in the field include the development of PROMs targeted at children with RMS specifically and expansion of PROM evaluation within clinical trials.
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Affiliation(s)
- Marloes van Gorp
- Princes Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sara Wakeling
- Founder, Alice’s Arc, Rhabdomyosarcoma Children’s Cancer Charity, London E4 7RW, UK
| | | | | | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Madeleine Adams
- Children’s Hospital for Wales, Cardiff CF14 4XW, UK
- Correspondence:
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Springvloet L, Triemstra M, Knottnerus B, Rolink M, Heijerman H, de Boer D. Validation of the CaReQoL asthma: a patient reported outcome measure for monitoring the perceived effects of pulmonary rehabilitation in adult patients with severe refractory asthma. Respir Res 2023; 24:14. [PMID: 36639773 PMCID: PMC9837900 DOI: 10.1186/s12931-022-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/06/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The CaReQoL Asthma assesses the care-related quality of life outcomes of pulmonary rehabilitation retrospectively in patients with severe asthma. The questionnaire comprises five domains (physical functioning; social functioning; coping with asthma; knowledge about asthma; medication). AIM To investigate construct and criterion validity of the CaReQoL Asthma, as well as its responsiveness and minimal important change (MIC), in comparison with other health measures (AQLQ, ACQ and FEV1). METHODS Eighty three adults with severe refractory asthma filled out the CaReQoL Asthma at 6 and 12 months after a 12-week personalized multidisciplinary pulmonary rehabilitation program in a tertiary asthma centre, either in Switzerland or The Netherlands. Construct validity and responsiveness were assessed by testing pre-defined hypotheses about associations with changes in AQLQ, ACQ and FEV1 scores. Criterion validity and MIC was assessed using Global Perceived Effect (GPE). Factor analyses, Cronbach's alpha, Spearman's correlations, paired t-tests and Student-Newman-Keuls tests were performed. RESULTS Cronbach's alphas of the questionnaire domains ranged from 0.82 to 0.95. Good construct validity and responsiveness were found; 84% of the assessed correlations confirm pre-defined hypotheses and reflect both weak and moderate to strong correlations. Good criterion validity was also identified, with CaReQol scores discriminating better than other health measures between levels of GPE at 6 months post-rehabilitation. The MIC for the total score was estimated at 0.84. CONCLUSION These study results suggest that the CaReQoL Asthma is a valid and responsive instrument and shows to be a comprehensive and tailored questionnaire for evaluating and monitoring outcomes of pulmonary rehabilitation in patients with severe refractory asthma. In order to further substantiate the reliability and validity of the CaReQoL Asthma, as well as to monitor outcomes of pulmonary rehabilitation in patients with severe asthma, it is recommended to use the CaReQoL Asthma in addition to other disease specific instruments.
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Affiliation(s)
- Linda Springvloet
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Mattanja Triemstra
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Bart Knottnerus
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Marlon Rolink
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Harry Heijerman
- grid.7692.a0000000090126352Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dolf de Boer
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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Wiegmann C, Quinlivan E, Michnevich T, Pittrich A, Ivanova P, Rohrbach AM, Kaminski J. A digital patient-reported outcome (electronic patient-reported outcome) system for patients with severe psychiatric disorders: User-centered development study and study protocol of a multicenter-controlled trial. Digit Health 2023; 9:20552076231191009. [PMID: 37900257 PMCID: PMC10605665 DOI: 10.1177/20552076231191009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/13/2023] [Indexed: 10/31/2023] Open
Abstract
Background The effective treatment of patients with severe psychiatric disorders primarily relies on subjective reporting of symptoms and side-effects. This information is crucial for a clinician's decision regarding medication adjustment. Treatment adjustment usually happens at a low frequency (∼4-8 weeks). In between points of care, patients are left alone with their symptoms and side-effects. This leads to uncertainty regarding the treatment, non-adherence, possible relapse, and rehospitalization. Objectives We aim to design a flexible electronic patient-reported outcome (ePRO) system, which allows patients with severe psychiatric disorders to: (a) record their symptoms using an app; (b) share the data with the clinical team at points of care; and (c) utilize the data to support therapy decisions. Methods In this article, we describe the development process which included the following steps: (a) formation of a co-design team; (b) stakeholder interviews with patients, practitioners, and digital health experts to access needs, requirements, and barriers; (c) prototype conceptualization and design; (d) user acceptance testing and refinement; and (e) finalization of the system for testing in a pilottrial. Results We included input from patients with lived experience of psychiatric disorders, clinical team members, software engineers, and researchers. A prototype system was refined, and iterative changes were made before finalization during a series of operational meetings. The system allows patients to digitally self-report their symptoms and provides longitudinal ePRO symptom data for export into the electronic health record. Conclusions Routine ePRO collection has the potential to improve outcomes and hereby also reduce health service costs. We have successfully developed a trial-ready ePRO system for severe psychiatric disorders. The findings were incorporated in the planning of a feasibility pilot trial. Assuming feasibility will be established, the system might be subjected to a certification process evaluation of safety and efficacy including a randomized controlled trial.
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Affiliation(s)
- Caspar Wiegmann
- Klinik für Psychiatrie und Psychotherapie, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Neurosciences CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Twyla Michnevich
- Department of Psychiatry and Neurosciences CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Petja Ivanova
- Hochschule für angewandte Wissenschaften, Hamburg, Germany
| | | | - Jakob Kaminski
- Department of Psychiatry and Neurosciences CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Gram EG, á Rogvi J, Heiberg Agerbeck A, Martiny F, Bie AKL, Brodersen JB. Methodological Quality of PROMs in Psychosocial Consequences of Colorectal Cancer Screening: A Systematic Review. Patient Relat Outcome Meas 2023; 14:31-47. [PMID: 36941831 PMCID: PMC10024469 DOI: 10.2147/prom.s394247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/18/2023] [Indexed: 03/15/2023] Open
Abstract
Objective This systematic review aimed to assess the adequacy of measurement properties in Patient-Reported Outcome Measures (PROMs) used to quantify psychosocial consequences of colorectal cancer screening among adults at average risk. Methods We searched four databases for eligible studies: MEDLINE, CINAHL, PsycINFO, and Embase. Our approach was inclusive and encompassed all empirical studies that quantified aspects of psychosocial consequences of colorectal cancer screening. We assessed the adequacy of PROM development and measurement properties for content validity using The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Results We included 33 studies that all together used 30 different outcome measures. Two PROMs (6.7%) were developed in a colorectal cancer screening context. COSMIN rating for PROM development was inadequate for 29 out of 30 PROMs (97%). PROMs lacked proper cognitive interviews and pilot studies and therefore had no proven content validity. According to the COSMIN checklist, 27 out of 30 PROMs (90%) had inadequate measurement properties for content validity. Discussion The majority of included PROMs had inadequate development and measurement properties. These findings shed light on the trustworthiness of the included studies' findings and call for reevaluation of existing evidence on the psychosocial consequences of colorectal cancer screening. To provide trustworthy evidence about the psychosocial consequences of colorectal cancer screening, editors could require that studies provide evidence of the methodological quality of the PROM. Alternatively, authors should transparently disclose their studies' methodological limitations in measuring psychosocial consequences of screening validly.
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Affiliation(s)
- Emma Grundtvig Gram
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice in Region Zealand, Region Zealand, Denmark
- Correspondence: Emma Grundtvig Gram, Email
| | - Jessica á Rogvi
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Heiberg Agerbeck
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Martiny
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Lykke Bie
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- The Center of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice in Region Zealand, Region Zealand, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, Tromsø, Norway
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van Oppen JD, Coats TJ, Conroy SP, Lalseta J, Richardson V, Riley P, Valderas JM, Mackintosh N. Co-creation of a Patient-Reported Outcome Measure for Older People Living with Frailty Receiving Acute Care (PROM-OPAC). J Patient Exp 2023. [DOI: 10.1177/23743735231158941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Older people living with frailty emphasize autonomy and function as acute healthcare outcome goals. Existing Patient-Reported Outcome Measures (PROMs) measure function but do not comprehensively address autonomy. This initial development of a novel autonomy outcome measure used co-creation and cognitive interviews, working toward a PROM for Older People living with frailty receiving Acute Care (“PROM-OPAC”). Novel item question stems and responses considering autonomy were devised with lay research partners. Items were examined for content by lay volunteers, and then selected based on relevance, completeness, and accessibility. Retained items were cognitively tested with patient participants. Item selection considered content validity and feasibility and was undertaken collaboratively with lay research partners. The study involved 3 lay research partners and 4 further lay collaborators throughout all stages, and 14 patient participants were recruited for the cognitive interviews. Twenty-two novel items were appraised. Seven were selected for retention. This preliminary PROM-OPAC comprised 7 items to measure autonomy and was intended for administration alongside a function measure to capture meaningful acute healthcare outcomes. Development will continue with quantitative testing and validation.
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Affiliation(s)
- James D. van Oppen
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Timothy J. Coats
- Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Simon P. Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Jagruti Lalseta
- Leicester, Leicestershire and Rutland Older Persons Patient and Public Involvement Forum, Leicester, UK
| | - Vivien Richardson
- Leicester, Leicestershire and Rutland Older Persons Patient and Public Involvement Forum, Leicester, UK
| | - Peter Riley
- Leicester, Leicestershire and Rutland Older Persons Patient and Public Involvement Forum, Leicester, UK
| | - Jose M. Valderas
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Holländer-Mieritz C, Elsborg AMJ, Kristensen CA, Rogers SN, Pappot H, Piil K. Recommendations for a Patient Concerns Inventory specific to patients with head and neck cancer receiving palliative treatment. Support Care Cancer 2023; 31:54. [DOI: 10.1007/s00520-022-07471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
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Horn J, Tostmann R, Dobel C, Löhler J, Guntinas-Lichius O. Die Perspektive der Patienten auf die HNO-Heilkunde – eine deutschlandweite Befragung. Laryngorhinootologie 2022. [PMID: 36543218 DOI: 10.1055/a-1970-6558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Zusammenfassung
Hintergrund Patientenorientierung zur Entscheidungsfindung für die beste Behandlung, aber auch die Patientenbeteiligung an Forschungsprojekten wird mehr gefordert.
Methoden In einer multizentrischen prospektiven Querschnittsstudie haben HNO-Patienten im Juni 2021 in 27 HNO-Praxen, 18 HNO-Kliniken und 14 Universitäts-HNO-Kliniken die Möglichkeit, einen Laien-gerechten Fragebogen mit Fragen zur Patientenorientierung, evidenzbasierten Medizin, Forschungsbedarf und Gesundheitskompetenz ausgefüllt.
Ergebnisse 2023 Patientenantworten (46% weiblich; 49% 46–75 Jahre alt; 40% in HNO-Praxis) wurden ausgewertet. Als HNO-Erkrankung war am häufigsten eine Sinnesstörung (16,8%) oder ein Tumor (12,7%) angegeben. Gemeinsam bei Therapieentscheidungen zu agieren, wurde als Entscheidungsprozess favorisiert (43,5%). Genügend Zeit für das Gespräch wurde als wichtigstes Element der Beziehung genannt (15,8%). Die meisten Teilnehmer fühlten sich über die Behandlungsschritte gut informiert (42,4%). Bei der elektronischen Suche wurden vor allem allgemeine Suchmaschinen verwendet (50,3%). Drei Viertel der Teilnehmer (73,7%) hatte noch nie an einer Studie teilgenommen. Etwa zwei Drittel (62,8%) konnten sich das auch für die Zukunft nicht vorstellen. Faktoren wie Geschlecht, Alter, Schulbildung oder Ort der Befragung waren mit anderem Antwortverhalten assoziiert.
Diskussion Der Wunsch nach Patientenorientierung ist auch bei HNO-Patienten hoch und von den HNO-Ärzten in Praxis und Klinik auch häufig umgesetzt. Insbesondere Patienten mit geringer Schulbildung sollten bei der Planung und Durchführung von Studien stärker eingebunden werden, um Partizipationsmöglichkeiten gemäß den Empfehlungen der Förderinstitutionen zu geben.
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Affiliation(s)
- Josephine Horn
- HNO-Klinik, Universitätsklinikum Jena, Jena, Deutschland
| | - Ralf Tostmann
- Studienzentrum UMG, Georg-August-Universität Göttingen Universitätsmedizin, Gottingen, Deutschland
| | | | - Jan Löhler
- HNO-Praxis Bad Bramstedt, Bad Bramstedt, Deutschland
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Dalmer S, Caulfield S, Murdoch F, Urschel S. Patient and care provider inclusion in the development of an educational graphic novel for heart transplanted teenagers. Pediatr Transplant 2022; 26:e14396. [PMID: 36124747 DOI: 10.1111/petr.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Teenagers experience high rates of rejection and organ failure after heart transplantation due to non-adherence to medications, poor transition into adult care, and difficulties communicating with adults including healthcare providers. This project aimed to creatively bridge this gap-including teenage patients, their parents, and healthcare providers in the development of a new resource meant to motivate teenage heart-transplant-patients to take interest and ownership of their long-term health. METHODS Four teenage heart-transplanted patients, four parents, and three healthcare providers provided insight into relevant content for an educational resource through semi-standardized questionnaires and interviews. Their input guided the style and substance of the resource developed under the supervision of Fine Arts professors and the pediatric heart transplant team. RESULTS Parents and healthcare providers were concerned about teenagers' health choices and lack of perspective while patients were more bothered by parental nagging and being careful about infections than worrying about post-transplant risks. The resource that was developed therefore used subtlety within a narrative medium: a graphic novel that involved mutant worms, secret plots, and daring escapes, to address identified medical concerns and encouragements without triggering teenage resistance to instruction. CONCLUSION The discrepancies between the priorities of healthcare providers, parents, and teenage heart-transplant-patients illustrate the significance of basing resource-development on input from the target population. We developed the first graphic novel written for teenage heart-transplant-patients with patient input and interdisciplinary cooperation, using the subtlety of a narrative medium as a model for integrating medical content within an appealing, motivational, patient-centered, and age-appropriate resource.
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Affiliation(s)
- Stephanie Dalmer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sean Caulfield
- Department of Art and Design, University of Alberta, Edmonton, Alberta, Canada
| | - Faye Murdoch
- Division of Pediatric Cardiology, Departments of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Departments of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Institute, University of Alberta, Li Ka Shing Centre For Health Research, Edmonton, Alberta, Canada
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