Health democracy in Europe: Cancer patient organization participation in health policy

Methods for Involving People With Dementia in Health Policy and Guideline Development: A Scoping Review

INTRODUCTION

Patient and public involvement (PPI) is considered part of best-practice for health care delivery, research and policy. However, people with dementia are frequently excluded from PPI initiatives. While recent studies have investigated PPI of people with dementia in research, little is known about their involvement at the macro-level of care, that is, in health policy and guideline development. This scoping review maps the evidence on PPI of people with dementia at the macro-level of care, focusing on the methods, outcomes and mechanisms of involvement.

METHODS

We systematically searched MEDLINE via PubMed, CINAHL, the Cochrane Library and GeroLit. Additionally, we performed forward and backward citation searching, manually tracked individual references, searched abstract books and yearbooks, and contacted authors of included reports to seek additional references. We analysed each method's mechanisms of involvement to assess whether measures were taken to maximise effective information transfer.

RESULTS

We included 43 reports and identified 35 involvement methods, which we structured into six categories: 'focus groups and interviews', 'surveys and questionnaires', 'public events', 'meetings with decision-makers', 'serving as members of working groups', and 'multiple-step methods'. Most of the involvement took the form of consultations during the early stages of policy or guideline development. All involvement methods required verbal communication skills, almost all of the participants had mild dementia. We found that most reports did not clearly state the involvement outcomes. While a majority of methods had some facilitation in place to elicit information from participating people with dementia, only nine methods used a structured aggregation to synthesise participants' contributions into a joint statement.

CONCLUSION

We found limited evidence of dementia-adapted involvement. Future research might focus on exploring the mechanisms of involvement to adapt methods to specific target groups, such as people with impaired verbal communication or advanced dementia. We recommend using existing guidance to report PPI initiatives, as the reporting was often incomplete, which limits reproducibility.

PATIENT OR PUBLIC CONTRIBUTION

We discussed both our study protocol and our results with a working group of people with dementia, who provided valuable insight for our data interpretation. Our findings can serve such groups for future consultations.

Patient organisations' views, motivations and experiences on patient involvement in cancer research: a pilot study in Portugal

OBJECTIVES

To characterise Portuguese cancer-related patient organisations and analyse their views, motivations and experiences on patient involvement in cancer research.

DESIGN

A multistakeholder group, comprising patient representatives and researchers, codesigned a questionnaire after a literature review, online sessions and collaborative mind maps. In May 2021, a survey was conducted among representatives of Portuguese cancer-related patient organisations, focusing on four dimensions: experience in cancer research; perception of its outcomes; motivations and expectations on patient involvement in research; and organisation characteristics.

PARTICIPANTS

Twenty-seven representatives from Portuguese cancer-related patient organisations responded to the questionnaire, corresponding to a 64% response rate.

RESULTS

Among the surveyed organisations, 26% have participated in clinical studies. Their involvement occurred in few stages of the research process and, mostly, with low levels of engagement. They showed 'great interest' in participating in most research steps, although this is not reflected in a high perception of influence over these same steps. More than half claimed to have contributed to the increase in patient recruitment and to a better understanding of informed consent by patients involved. Ensuring that research results are more aligned with the true needs of patients is the greatest motivation. Also, our results suggest that the organisation's number of employees and its integration into a European/International network play a relevant role in patient involvement in research.

CONCLUSIONS

This study provides the first in-depth characterisation of Portuguese cancer-related patient organisations and their views, motivations and experiences on patient involvement in cancer research. Most importantly, this study revealed that most of these organisations show great interest in being involved in different R&D stages to ensure that research results are aligned with patients' needs. Their motivation should be turned into greater and more meaningful involvement in practice, so that the cancer community can benefit from the outcomes of truly patient-centred research.

Nursing Leaders as Visionaries and Enablers of Action

OBJECTIVES

The engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.

DATA SOURCES

Author experience, journal articles and organizational position papers were used.

CONCLUSION

To improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.

IMPLICATIONS FOR NURSING PRACTICE

Nursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

Indices and Indicators Developed to Evaluate the "Strengthening Community Actions" Mechanism of the Ottawa Charter for Health Promotion: A Scoping Review

OBJECTIVE

To determine 1) the indexes/indicators used for evaluating the "strengthening community actions" mechanism of the Ottawa Charter for Health Promotion and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review.Data Source:In May 2020, the search was conducted across three databases: Medline (via PubMed), Embase, and Scopus.Inclusion and Exclusion Criteria: All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the "strengthening community actions" were included. The review articles were excluded.

DATA EXTRACTION

The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data.

DATA SYNTHESIS

To summarize and report the data, a descriptive numerical analysis and a narrative descriptive synthesizing approach were used.

RESULTS

In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n = 3), community capacity (n = 1), community participation (n = 7), social capital (n = 6), social network (n = 3), social support (n = 1), and others (n = 5).

CONCLUSIONS

Having a collection of "strengthening community actions" indices/indicators in hand, health policymakers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.

Patient involvement at the managerial level: the effectiveness of a patient and family advisory council at a regional cancer centre in Sweden

BACKGROUND

In cancer care as well as other types of treatment and care, little is known about the contribution of Patient and Family Advisory Councils (PFACs) operating at the managerial level in healthcare organizations. The aim of the study was to investigate the effectiveness of a Swedish PFAC operating at the managerial level at one of Sweden's six regional cancer centres.

METHODS

This was a qualitative, single-case study based on interviews with PFAC participants and meeting minutes from PFAC meetings. These were analysed using a modified version of a framework developed by Abelson et al. to design and evaluate collective involvement processes in the healthcare sector: (i) representation; (ii) information; (iii) process or procedures and (iv) outcomes and decisions.

RESULTS

The descriptive representation was good regarding geographical location and cancer diagnosis. Information from the regional cancer centre was an important part of the meeting agenda. The procedures encouraged everyone to speak up, and the participants saw the representatives from the regional cancer centre as allies against the hospitals and regions, raising some questions about the PFAC's independence. Regarding outcomes, most participants did not know to what extent their work had led to any improvements in cancer care. However, they still regarded the council as effective, as issues the participants raised were listened to by the representatives from the regional cancer centre and 'taken further' in the healthcare organization.

CONCLUSIONS

The participants were satisfied with being listened to, but they found it difficult to know whether their work had led to improvements, in part because they did not know enough about how the healthcare organization worked above the care-provision level. This was a hurdle to achieving change. The study suggests it is more difficult for patients and next of kin to participate at the managerial level, compared to the care-provision level in healthcare systems, where they could potentially influence important aspects of cancer care and policy, since it is at these levels strategic decisions about priorities in cancer care and service configurations are made. This indicates that there is a particular need for guidance and support for patient and public involvement to work successfully at this level, which may include relevant education and training in system knowledge.

The Precision Health and Everyday Democracy (PHED) Project: Protocol for a Transdisciplinary Collaboration on Health Equity and the Role of Health in Society

Background

The project “Precision Health and Everyday Democracy” (PHED) is a transdisciplinary partnership that combines a diverse range of perspectives necessary for understanding the increasingly complex societal role played by modern health care and medical research. The term “precision health” is being increasingly used to express the need for greater awareness of environmental and genomic characteristics that may lead to divergent health outcomes between different groups within a population. Enhancing awareness of diversity has parallels with calls for “health democracy” and greater patient-public participation within health care and medical research. Approaching health care in this way goes beyond a narrow focus on the societal determinants of health, since it requires considering health as a deliberative space, which occurs often at the banal or everyday level. As an initial empirical focus, PHED is directed toward the health needs of marginalized migrants (including refugees and asylum seekers, as well as migrants with temporary residency, often involving a legally or economically precarious situation) as vulnerable groups that are often overlooked by health care. Developing new transdisciplinary knowledge on these groups provides the potential to enhance their wellbeing and benefit the wider society through challenging the exclusions of these groups that create pockets of extreme ill-health, which, as we see with COVID-19, should be better understood as “acts of self-harm” for the wider negative impact on humanity.

Objective

We aim to establish and identify precision health strategies, as well as promote equal access to quality health care, drawing upon knowledge gained from studying the health care of marginalized migrants.

Methods

The project is based in Sweden at Malmö and Lund Universities. At the outset, the network activities do not require ethical approval where they will not involve data collection, since the purpose of PHED is to strengthen international research contacts, establish new research within precision strategies, and construct educational research activities for junior colleagues within academia. However, whenever new research is funded and started, ethical approval for that specific data collection will be sought.

Results

The PHED project has been funded from January 1, 2019. Results of the transdisciplinary collaboration will be disseminated via a series of international conferences, workshops, and web-based materials. To ensure the network project advances toward applied research, a major goal of dissemination is to produce tools for applied research, including information to enhance health accessibility for vulnerable communities, such as marginalized migrant populations in Sweden.

Conclusions

There is a need to identify tools to enable the prevention and treatment of a wide spectrum of health-related outcomes and their link to social as well as environmental issues. There is also a need to identify and investigate barriers to precision health based on democratic principles.

International Registered Report Identifier (IRRID)

DERR1-10.2196/17324

Legislating Patient Representation: A Comparison Between Austrian and German Regulations on Self-Help Organizations as Patient Representatives

Governments are increasingly inviting patient organizations (POs) to participate in healthcare policymaking. By inviting POs that claim to represent patients, representation comes into being. However, little is known about the circumstances under which governments accept POs as patient representatives. Based on the analysis of relevant legislation, this article investigates the criteria that self-help organizations (SHOs), a special type of PO, must fulfil in order to be accepted as patient representatives by governments in Austria and Germany. Thereby, it aims to contribute to the discussion on the role of governments in steering SHOs. There are different degrees of regulation (very little in Austria, more in Germany). Governments in both countries not only formulate explicit criteria for SHOs with respect to patient representation but also guide SHOs representing patients through implicit criteria for associations. We discuss the findings against concepts of responsiveness, authorization, and accountability. Our findings indicate that governmental steering is not negative per se as indicated by previous research but-depending on legislative criteria-can promote transparency and democratic quality in patient representation.

Cancer patients' organisation participation in heath policy decision-making: a snapshot/cluster analysis of the EU-28 countries

OBJECTIVES

Even though patient involvement in health policy decision-making is well documented, studies evaluating the degree and impact of this participation are scarce. This is even more conspicuous in the case of cancer. There is evidence showing that patients with the same type of cancer and at the same stage of the disease will receive different treatments in different countries. Therefore, it is crucial to assess the degree of patient participation in health policy decision-making across Europe, as it may result in health inequalities across countries. In a response to this research call, the present study aimed to provide a snapshot of cancer patients' organisation (CPO) participation in health policy processes in European Union (EU)-28 countries.

SETTING

CPOs from the EU-28 countries.

PARTICIPANTS

Primary and secondary outcome measures: information about participants' sociodemographic characteristics and their involvement in their CPO was collected as well as data about the CPO. A 17-item index containing questions about the type and impact of participation in various facets of health policy decision-making was used to assess the degree of CPOs participation in health policy decision-making processes and its impact.

Health democracy in Europe: Cancer patient organization participation in health policy

BACKGROUND

Patient organization participation in health policy decision making is an understudied area of inquiry. A handful of qualitative studies have suggested that the growing number of patient organizations in Europe and their increasing involvement in policy issues do not result in high political effectiveness. However, existing research is largely country-specific.

OBJECTIVE

To examine the degree and impact of cancer patient organization (CPO) participation in health policy decision making in EU-28 and to identify their correlates.

METHODS

A total of 1266 members of CPOs participated in this study, recruited from a diversity of sources. CPO participation in health policy was assessed with the Health Democracy Index, a previously developed instrument measuring the degree and impact of patient organization participation in various realms of health policy. Additional questions collected information about participants' and the CPO's characteristics. Data were gleaned in the form of an online self-reported instrument.

RESULTS

The highest degree of CPO participation was observed with respect to hospital boards, reforms in health policy and ethics committees for clinical trials. On the contrary, the lowest was discerned with regard to panels in other important health-related organizations and in the Ministry of Health. The reverse pattern of results was observed concerning the Impact subscale. As regards the correlates of CPO participation, legislation bore the strongest association with the Degree subscale, while organizational factors emerged as the most important variables with regard to the Impact subscale.

CONCLUSIONS

Research findings indicate that a high degree of CPO participation does not necessarily ensure a high impact. Efforts to promote high and effective CPO participation should be geared towards the establishment of a health-care law based on patient rights as well as to the formation of coalitions among CPOs and the provision of training to its members.