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Halstrom A, Lin IH, Lin A, Cohen M, Tabar V, Geer EB. Different patient versus provider perspectives on living with Cushing's disease. Pituitary 2024; 27:141-150. [PMID: 38315244 PMCID: PMC11009766 DOI: 10.1007/s11102-024-01381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
CONTEXT Patients with Cushing's disease (CD) face challenges living with and receiving appropriate care for this rare, chronic condition. Even with successful treatment, many patients experience ongoing symptoms and impaired quality of life (QoL). Different perspectives and expectations between patients and healthcare providers (HCPs) may also impair well-being. OBJECTIVE To examine differences in perspectives on living with CD between patients and HCPs, and to compare care goals and unmet needs. DESIGN Memorial Sloan Kettering Pituitary Center established an annual pituitary symposium for pituitary patients and HCPs. Through anonymous pre-program surveys distributed at the 2020 and 2022 symposia, patients and HCPs answered questions related to their own sense, or perception of their patients' sense, of hope, choice, and loneliness in the context of living with CD. PARTICIPANTS From 655 participants over two educational events, 46 patients with CD and 116 HCPs were included. Median age of both groups was 51 years. 78.3% of the patients were female vs. 53.0% of the HCPs. RESULTS More patients than HCPs reported they had no choices in their treatment (21.7% vs. 0.9%, P < 0.001). More patients reported feeling alone living with CD than HCPs' perception of such (60.9% vs. 45.5%, P = 0.08). The most common personal care goal concern for patients was 'QoL/mental health,' vs. 'medical therapies/tumor control' for HCPs. The most common CD unmet need reported by patients was 'education/awareness' vs. 'medical therapies/tumor control' for HCPs. CONCLUSIONS CD patients experience long term symptoms and impaired QoL which may in part be due to a perception of lack of effective treatment options and little hope for improvement. Communicating experiences and care goals may improve long term outcomes for CD patients.
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Affiliation(s)
- Amanda Halstrom
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - I-Hsin Lin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Lin
- Multidisciplinary Pituitary & Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Cohen
- Multidisciplinary Pituitary & Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viviane Tabar
- Multidisciplinary Pituitary & Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eliza B Geer
- Multidisciplinary Pituitary & Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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McDonald IR, Blocker ES, Weyman EA, Smith N, Dwyer AA. What Are the Best Practices for Co-Creating Patient-Facing Educational Materials? A Scoping Review of the Literature. Healthcare (Basel) 2023; 11:2615. [PMID: 37830651 PMCID: PMC10572900 DOI: 10.3390/healthcare11192615] [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: 08/31/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Co-creating patient-facing educational materials (PEMs) can enhance person-centered care by responding to patient priorities and unmet needs. Little data exist on 'best practices' for co-creation. We followed the Arksey and O'Malley framework to conduct a systematic literature search of nine databases (MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Joanna Briggs Institute, TRIP-April, 2022) to identify empirical studies published in English on PEM co-creation to distill 'best practices'. Following an independent dual review of articles, data were collated into tables, and thematic analysis was employed to synthesize 'best practices' that were validated by a patient experienced in co-creating PEMs. Bias was not assessed, given the study heterogeneity. Of 6998 retrieved articles, 44 were included for data extraction/synthesis. Studies utilized heterogeneous methods spanning a range of health conditions/populations. Only 5/45 (11%) studies defined co-creation, 14 (32%) used a guiding framework, and 18 (41%) used validated evaluation tools. Six 'best practices' were identified: (1) begin with a review of the literature, (2) utilize a framework to inform the process, (3) involve clinical and patient experts from the beginning, (4) engage diverse perspectives, (5) ensure patients have the final decision, and (6) employ validated evaluation tools. This scoping review highlights the need for clear definitions and validated evaluation measures to guide and assess the co-creation process. Identified 'best practices' are relevant for use with diverse patient populations and health issues to enhance person-centered care.
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Affiliation(s)
- Isabella R. McDonald
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA; (I.R.M.); (E.S.B.); (E.A.W.)
| | - Elizabeth S. Blocker
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA; (I.R.M.); (E.S.B.); (E.A.W.)
| | - Elizabeth A. Weyman
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA; (I.R.M.); (E.S.B.); (E.A.W.)
| | - Neil Smith
- “I Am HH” Patient Organization, Dallas, TX 75238, USA;
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA; (I.R.M.); (E.S.B.); (E.A.W.)
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Boston, MA 02114, USA
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study. Orphanet J Rare Dis 2023; 18:7. [PMID: 36624535 PMCID: PMC9828378 DOI: 10.1186/s13023-022-02604-2] [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: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL. METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions. RESULTS The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'. CONCLUSIONS The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.
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Affiliation(s)
- Agnes Kocher
- Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5734.50000 0001 0726 5157Department of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A. Dwyer
- grid.208226.c0000 0004 0444 7053Boston College, Connell School of Nursing, Chestnut Hill, MA USA ,grid.32224.350000 0004 0386 9924Center for Nursing Research, Massachusetts General Hospital Munn, Boston, MA USA
| | - Catherine Blatter
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Jasmina Bogdanovic
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Patrizia Künzler-Heule
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.413349.80000 0001 2294 4705Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.413349.80000 0001 2294 4705Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Diana Dan
- grid.9851.50000 0001 2165 4204Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- grid.7400.30000 0004 1937 0650Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A. Walker
- grid.410567.1Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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Falcão M, Allocca M, Rodrigues AS, Granjo P, Francisco R, Pascoal C, Rossi MG, Marques-da-Silva D, Magrinho SCM, Jaeken J, Castro LA, de Freitas C, Videira PA, de Andrés-Aguayo L, dos Reis Ferreira V. A Community-Based Participatory Framework to Co-Develop Patient Education Materials (PEMs) for Rare Diseases: A Model Transferable across Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:968. [PMID: 36673723 PMCID: PMC9859511 DOI: 10.3390/ijerph20020968] [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: 11/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
At least 50% of chronic disease patients don't follow their care plans, leading to lower health outcomes and higher medical costs. Providing Patient Education Materials (PEMs) to individuals living with a disease can help to overcome these problems. PEMs are especially beneficial for people suffering from multisystemic and underrecognized diseases, such as rare diseases. Congenital disorders of glycosylation (CDG) are ultra-rare diseases, where a need was identified for PEMs in plain language that can clearly explain complex information. Community involvement in the design of PEMs is extremely important for diseases whose needs are underserved, such as rare diseases; however, attempts to involve lay and professional stakeholders are lacking. This paper presents a community-based participatory framework to co-create PEMs for CDG, that is transferable to other diseases. A literature review and questionnaire were performed, and only four articles describing the development of PEMS for rare diseases have been found, which demonstrates a lack of standardized approaches. The framework and PEMs were co-developed with CDG families and will be crucial in increasing health literacy and empowering families. We will close a gap in the creation of PEMs for CDG by delivering these resources in lay language in several languages.
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Affiliation(s)
- Marta Falcão
- Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon, 1349-008 Lisbon, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
| | - Mariateresa Allocca
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Institute of Biomolecular Chemistry, National Research Council of Italy, 80078 Pozzuoli, Italy
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Ana Sofia Rodrigues
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Pedro Granjo
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Rita Francisco
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Carlota Pascoal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Maria Grazia Rossi
- IFILNOVA—Institute of Philosophy—Faculty of Social Sciences and Humanities, NOVA University of Lisbon, 1069-061 Lisbon, Portugal
| | - Dorinda Marques-da-Silva
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Salvador C. M. Magrinho
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- LAQV (Associate Lab for Green Chemistry)—Chemistry Department, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
| | - Jaak Jaeken
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Centre of Metabolic Diseases, Department of Pediatrics, KU Leuven, 3000 Leuven, Belgium
| | - Larisa Aragon Castro
- Swiss Personalized Health Network (SPHN), 3001 Bern, Switzerland
- EUPATI—European Patient’s Academy on Therapeutic Innovation, 3008 Bern, Switzerland
- SNSF Swiss National Science Foundation, 3001 Bern, Switzerland
| | - Cláudia de Freitas
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- EPI Unit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Paula A. Videira
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Luísa de Andrés-Aguayo
- Center for Genomic Regulation (CRG), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
| | - Vanessa dos Reis Ferreira
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
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McDonald IR, Welt CK, Dwyer AA. Health-related quality of life in women with primary ovarian insufficiency: a scoping review of the literature and implications for targeted interventions. Hum Reprod 2022; 37:2817-2830. [PMID: 36102839 PMCID: PMC9989734 DOI: 10.1093/humrep/deac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What is known about health-related quality of life (HR-QoL) in women with idiopathic primary ovarian insufficiency (POI)? SUMMARY ANSWER Women with POI have a range of unmet psychosocial needs relating to three interrelated themes: 'diagnostic odyssey', 'isolation and stigma' and impaired 'ego integrity'. WHAT IS KNOWN ALREADY Prior studies have reported increased depressive symptoms, diminished sexual function and altered body image/self-concept in women with POI. STUDY DESIGN, SIZE, DURATION A systematic scoping review (11 databases) on HR-QoL in POI including published quantitative, qualitative and mixed-methods studies as well as unpublished gray literature (i.e. unpublished dissertations) through June, 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS After removing duplicates, 1244 articles underwent title and abstract review by independent reviewers. The remaining 72 relevant articles underwent dual full text review to determine inclusion criteria yielding 24 articles (100% concordance) for data extraction. Findings were summarized in tables by methodology and recurrent HR-QoL themes/sub-themes were mapped to define key aspects of HR-QoL in POI. Promoters of active coping were charted at the individual, interpersonal and healthcare system levels. Targets for tailored interventions supporting active coping and improved HR-QoL were mapped to the Theory of Planned Behavior (TPB). MAIN RESULTS AND THE ROLE OF CHANCE Three interrelated themes affecting HR-QoL in POI emerged from the data synthesis. First, the theme 'diagnostic odyssey' comprised sub-themes of uncertainty, lack of control, knowledge gaps, discontinuous care and negative clinical interactions. The second theme 'isolation and stigma' included sub-themes of guilt, shame, concealment, feeling labeled as infertile, lack of social support and unsympathetic clinicians. The third theme, impaired 'ego integrity' captured sub-themes of decreased sexual function, altered body image, psychological vulnerability and catastrophizing. Targets promoting active coping at the individual (n = 2), interpersonal (n = 1) and healthcare system (n = 1) levels were mapped to the TPB to inform development of tailored interventions supporting active coping and improved HR-QoL in POI (i.e. narrative intervention, co-creating patient-facing materials, peer-to-peer support and provider resources). LIMITATIONS, REASONS FOR CAUTION No studies using a POI-specific HR-QoL instrument were identified. No interventional studies aimed at improving HR-QoL in POI were identified. Only articles published in English were included in the study. WIDER IMPLICATIONS OF THE FINDINGS Women with POI frequently have impaired HR-QoL related to the life-altering infertility diagnosis. The range of unmet psychosocial needs may be relevant for informing interventions for other populations with infertility. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development 'Massachusetts General Hospital-Harvard Center for Reproductive Medicine' (1 P50 HD104224-01 NICHD). The authors have no conflicts to declare. REGISTRATION NUMBER N/A.
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Affiliation(s)
- Isabella R McDonald
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Corrine K Welt
- Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, UT, USA.,Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Boston, MA, USA
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.,Massachusetts General Hospital-Harvard Center for Reproductive Medicine, Boston, MA, USA
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Francisco R, Alves S, Gomes C, Granjo P, Pascoal C, Brasil S, Neves A, Santos I, Miller A, Krasnewich D, Morava E, Lam C, Jaeken J, Videira PA, dos Reis Ferreira V. A Participatory Framework for Plain Language Clinical Management Guideline Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13506. [PMID: 36294089 PMCID: PMC9603256 DOI: 10.3390/ijerph192013506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology. RESULTS We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community's needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources. CONCLUSIONS This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.
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Affiliation(s)
- Rita Francisco
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Susana Alves
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Sci and Volunteer Program from NOVA School of Science and Technology/FCT NOVA, NOVA University Lisbon, Caparica, 2825-149 Setúbal, Portugal
| | - Catarina Gomes
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Sci and Volunteer Program from NOVA School of Science and Technology/FCT NOVA, NOVA University Lisbon, Caparica, 2825-149 Setúbal, Portugal
| | - Pedro Granjo
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Sci and Volunteer Program from NOVA School of Science and Technology/FCT NOVA, NOVA University Lisbon, Caparica, 2825-149 Setúbal, Portugal
| | - Carlota Pascoal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Sandra Brasil
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Alice Neves
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Sci and Volunteer Program from NOVA School of Science and Technology/FCT NOVA, NOVA University Lisbon, Caparica, 2825-149 Setúbal, Portugal
| | - Inês Santos
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Sci and Volunteer Program from NOVA School of Science and Technology/FCT NOVA, NOVA University Lisbon, Caparica, 2825-149 Setúbal, Portugal
| | | | - Donna Krasnewich
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20814, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN 55905, USA
- Metabolic Centre, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Medical Genetics, Medical School, University of Pécs, 7622 Pecs, Hungary
| | - Christina Lam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Jaak Jaeken
- Centre of Metabolic Diseases, KU Leuven, 3000 Leuven, Belgium
| | - Paula A. Videira
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Vanessa dos Reis Ferreira
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
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Long JC, Best S, Nic Giolla Easpaig B, Hatem S, Fehlberg Z, Christodoulou J, Braithwaite J. Needs of people with rare diseases that can be supported by electronic resources: a scoping review. BMJ Open 2022; 12:e060394. [PMID: 36581982 PMCID: PMC9438091 DOI: 10.1136/bmjopen-2021-060394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Rare diseases are characterised by low incidence, often with little evidence for effective treatments. Isolated patients and specialist centres for rare diseases are increasingly connected, thanks to the internet. This scoping review aimed to identify issues facing people with a rare disease that authors report may be addressed by electronic resources (mobile applications, websites, social media platforms, telehealth and online portals). DESIGN Scoping review guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. DATA SOURCES Medline, Embase and PsycInfo were searched, supplemented by hand searches of selected journals, in July 2021. ELIGIBILITY CRITERIA Peer-reviewed literature in English was searched using terms for rare disease (incidence <1:2000), electronic modalities (eg, mobile phone) and patient support terms. No date limit was set. Conference abstracts were included. DATA EXTRACTION AND SYNTHESIS Data extracted: rare disease/group of diseases, name of the e-resource, need identified in the patient cohort, features of the e-resource, any other findings or observations of interest. From this, a framework was developed synthesising features across diseases and resources. RESULTS Seventy-two papers were found (from 383). Fifty-six electronic resources were described in 64 papers, while 12 papers were exploratory studies. Cystic fibrosis (n=28) was the most frequently addressed, followed by haemophilia (n=16).Four domains and 23 subdomains of needs were extracted from the papers. The domains of needs were: support for self-management, access to high-quality information, access to appropriate specialist services, and social support. Subdomains are sometimes related to needs of individual rare diseases (eg, social isolation due to infection risk in people with cystic fibrosis). Fifteen electronic resources were identified that supported parents of children with rare disorders. CONCLUSIONS While it can be argued that rare diseases, per se, may be no less distressing or onerous to care for than a high prevalence disease, rare diseases have unique features: the lengthy odyssey to find a diagnosis, then appropriate specialists, the lack of evidence around effective treatments, guidelines or access to knowledgeable general health service providers. Designers of electronic resources are urged to consult key stakeholders to enhance the effectiveness and usability of resources for people with a rare disease.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zoe Fehlberg
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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8
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Velvin G, Hartman T, Bathen T. Patient involvement in rare diseases research: a scoping review of the literature and mixed method evaluation of Norwegian researchers' experiences and perceptions. Orphanet J Rare Dis 2022; 17:212. [PMID: 35642001 PMCID: PMC9158134 DOI: 10.1186/s13023-022-02357-y] [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: 12/14/2021] [Accepted: 05/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Patients’ involvement (PI) in research is recognized as a valuable strategy for increasing the quality, developing more targeted research and to speed up more innovative research dissemination. Nevertheless, patient involvement in rare diseases research (PI-RDR) is scarce. The aims were: To study the Norwegian researchers` experiences and perceptions of PI-RDR and review the literature on PI-RDR. Methods 1. A systematic scoping review of the literature on PI-RDR. 2. A cross-sectional questionnaire study with close-ended and open-ended questions to investigate the researchers` experiences. Results In the scoping review 608 articles read in full-text and 13 articles (one review and twelve primary studies) were included. The heterogeneity of the design, methodology and results was large. Most studies described several benefits of PI, but few described methods for measuring impacts and effectiveness of PI-RDR. In the cross sectional part of this study, 145 of 251 employees working in the nine Norwegian Centers on Rare Diseases participated, of these 69 were researchers. Most (95%) of the researchers claimed that rare diseases research is more challenging than for the more common diseases. The majority (95%) argued that PI-RDR may increase the quality of the studies and the relevance, and most (89%) agreed that PI-RDR in dissemination may increase the awareness and public interest for rare diseases. In the open-ended questions several researchers also claimed challenges related to PI-RDR, and many had proposal for improving PI and promotion of rare disease research. Conclusion Both the literature and researchers emphasized that PI-RDR is important for improving research quality and increase the public attention on rare diseases, but what constitutes effective PI-RDR still remain unclear. More research on the design, methodology and assessment for measuring the impact of PI-RDR is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02357-y.
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Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Nesodden, Oslo, Norway.
| | - Thale Hartman
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Nesodden, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Nesodden, Oslo, Norway
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9
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Francisco R, Brasil S, Pascoal C, Jaeken J, Liddle M, Videira PA, Dos Reis Ferreira V. The road to successful people-centric research in rare diseases: the web-based case study of the Immunology and Congenital Disorders of Glycosylation questionnaire (ImmunoCDGQ). Orphanet J Rare Dis 2022; 17:134. [PMID: 35331276 PMCID: PMC8944152 DOI: 10.1186/s13023-022-02286-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Background Congenital Disorders of Glycosylation (CDG) are a complex family of rare metabolic diseases. Robust clinical data collection faces many hurdles, preventing full CDG biological and clinical comprehension. Web-based platforms offer privileged opportunities for biomedical data gathering, and participant recruitment, particularly in rare diseases. The immunology and CDG electronic (e-) questionnaire (ImmunoCDGQ) explores this paradigm, proposing a people-centric framework to advance health research and participant empowerment. Objective The objectives of this study were to: (1) Describe and characterize the ImmunoCDGQ development, engagement, recruitment, participation, and result dissemination strategies; (2) To critically compare this framework with published literature and making recommendations. Methods An international, multistakeholder people-centric approach was initiated to develop and distribute the ImmunoCDGQ, a multi-lingual e-questionnaire able to collect immune-related data directly from patients and family caregivers. An adapted version was produced and distributed among the general “healthy” population (ImmunoHealthyQ), serving as the control group. Literature screening was performed to identify and analyze comparable studies. Results The ImmunoCDGQ attained high participation and inclusion rates (94.6%, 209 out of 221). Comparatively to the control, CDG participants also showed higher and more variable questionnaire completion times as well as increased English version representativeness. Additionally, 20% of the CDG group (42 out of 209) chose not to complete the entire questionnaire in one go. Conditional logic structuring guided participant data provision and accurate data analysis assignment. Multi-channel recruitment created sustained engagement with Facebook emerging as the most followed social media outlet. Still, most included ImmunoCDGQ questionnaires (50.7%, 106 out of 209) were submitted within the first month of the project’s launch. Literature search and analysis showed that most e-questionnaire-based studies in rare diseases are author-built (56.8%, 25 out of 44), simultaneously addressing medical and health-related quality of life (HRQoL) and/or information needs (79.5%, 35 out of 44). Also, over 68% of the studies adopt multi-platform recruitment (30 out of 44) actively supported by patient organizations (52.3%, 23 out of 44). Conclusions The ImmunoCDGQ, its methodology and the CDG Community served as models for health research, hence paving a successful and reproducible road to people-centricity in biomedical research. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02286-w.
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Affiliation(s)
- Rita Francisco
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Sandra Brasil
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Carlota Pascoal
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Jaak Jaeken
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Center for Metabolic Diseases, Department of Pediatrics, KU Leuven, 3000, Leuven, Belgium
| | - Merell Liddle
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Paula A Videira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Vanessa Dos Reis Ferreira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.
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10
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Yu B, Chen K, Mao J, Hou B, You H, Wang X, Nie M, Huang Q, Zhang R, Zhu Y, Sun B, Feng F, Zhou W, Wu X. The diagnostic value of the olfactory evaluation for congenital hypogonadotropic hypogonadism. Front Endocrinol (Lausanne) 2022; 13:909623. [PMID: 36187095 PMCID: PMC9523726 DOI: 10.3389/fendo.2022.909623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic accuracy of different olfactory evaluation tools in congenital hypogonadotropic hypogonadism (CHH) patients. METHODS Seventy-one CHH patients were prospectively recruited at Peking Union Medical College Hospital between November 2020 and July 2021. The Chinese Olfactory Function Test (COFT) and Self-reported Olfactory Scale (SROS) were adapted as the subjective tools for the evaluation of olfactory function, and magnetic resonance imaging of olfactory apparatus (MRI-OA) was the objective tool. The olfactory bulb volume (OBV) and the olfactory sulcus depth (OSD) were quantified. RESULTS Based on the COFT, 36 patients were categorized as having normosmic CHH (nCHH), and the other 35 patients were categorized as having Kallmann syndrome (KS). Among nCHH patients, 35 patients were classified as having normal olfaction and 1 patient had abnormal olfaction by SROS. For KS patients, there were 30 patients grouped into abnormal olfaction, while 5 patients had normal olfaction by SROS. For MRI-OA, 67% (18/27) of nCHH patients showed normal olfactory apparatus, and 33% (9/27) showed bilateral or unilateral olfactory bulb aplasia or hypoplasia. Among KS patients, 96% (27/28) of patients showed bilateral olfactory bulb hypoplasia or aplasia, and 4% (1/28) of patients showed normal olfactory apparatus. All six patients with unilateral olfactory bulb aplasia and three patients with bilateral olfactory bulb aplasia showed normal olfactory function. The accuracy of the SROS in the diagnosis of nCHH and KS was 91.5%, with a sensitivity of 0.857 and a specificity of 0.972, while the accuracy of MRI-OA is 92.7%, with a sensitivity of 0.964 and a specificity of 0.889. CONCLUSION SROS and MRI-OA both showed high accuracy to distinguish between KS and nCHH. The abnormal structure of the olfactory apparatus was relatively common in nCHH patients. CHH patients with unilateral olfactory bulb aplasia dysplasia usually had normal olfaction. Normal olfaction without apparent olfactory bulbs is rare but occurred in male CHH patients.
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Affiliation(s)
- Bingqing Yu
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kepu Chen
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Chinese Academy of Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiangfeng Mao
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xi Wang
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Nie
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qibin Huang
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Zhang
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiyi Zhu
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bang Sun
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wen Zhou
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Chinese Academy of Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xueyan Wu
- National Health Commission, Key laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xueyan Wu,
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11
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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12
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Dwyer AA, Zeng Z, Lee CS. Validating online approaches for rare disease research using latent class mixture modeling. Orphanet J Rare Dis 2021; 16:209. [PMID: 33971926 PMCID: PMC8108361 DOI: 10.1186/s13023-021-01827-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background Rare disease patients are geographically dispersed, posing challenges to research. Some researchers have partnered with patient organizations and used web-based approaches to overcome geographic recruitment barriers. Critics of such methods claim that samples are homogenous and do not represent the broader patient population—as patients recruited from patient organizations are thought to have high levels of needs. We applied latent class mixture modeling (LCMM) to define patient clusters based on underlying characteristics. We used previously collected data from a cohort of patients with congenital hypogonadotropic hypogonadism who were recruited online in collaboration with a patient organization. Patient demographics, clinical information, Revised Illness Perception Questionnaire (IPQ-R) scores and Zung self-rating depression Scale (SDS) were used as variables for LCMM analysis. Specifically, we aimed to test the classic critique that patients recruited online in collaboration with a patient organization are a homogenous group with high needs. We hypothesized that distinct classes (clinical profiles) of patients could be identified—thereby demonstrating the validity of online recruitment and supporting transferability of findings. Results In total, 154 patients with CHH were included. The LCMM analysis identified three distinct subgroups (Class I: n = 84 [54.5%], Class II: n = 41 [26.6%], Class III: n = 29 [18.8%]) that differed significantly in terms of age, education, disease consequences, emotional consequences, illness coherence and depression symptoms (all p < 0.001) as well as age at diagnosis (p = 0.045). Classes depict a continuum of psychosocial impact ranging from severe to relatively modest. Additional analyses revealed later diagnosis (Class I: 19.2 ± 6.7 years [95% CI 17.8–20.7]) is significantly associated with worse psychological adaptation and coping as assessed by disease consequences, emotional responses, making sense of one’s illness and SDS depressive symptoms (all p < 0.001). Conclusions We identify three distinct classes of patients who were recruited online in collaboration with a patient organization. Findings refute prior critiques of patient partnership and web-based recruitment for rare disease research. This is the first empirical data suggesting negative psychosocial sequelae of later diagnosis (“diagnostic odyssey”) often observed in CHH.
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Affiliation(s)
- Andrew A Dwyer
- Boston College Connell School of Nursing, Chestnut Hill, MA, USA. .,Massachusetts General Hospital - Harvard Center for Reproductive Medicine, Boston, MA, USA.
| | - Ziwei Zeng
- Boston College Lynch School of Education and Human Development, Center for Measurement, Evaluation, Statistics and Assessment, Chestnut Hill, MA, USA
| | - Christopher S Lee
- Boston College Connell School of Nursing, Chestnut Hill, MA, USA.,Eileen O'Connor Institute of Nursing Research, Australian Catholic University, Melbourne, Australia
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Marsilio M, Fusco F, Gheduzzi E, Guglielmetti C. Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3336. [PMID: 33804862 PMCID: PMC8037812 DOI: 10.3390/ijerph18073336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022]
Abstract
Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives.
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Affiliation(s)
- Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
| | - Floriana Fusco
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
| | - Eleonora Gheduzzi
- School of Management, Politecnico di Milano, via Lambruschini 4, 20156 Milan, Italy;
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
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14
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Iotova V, Schalin-Jäntti C, Bruegmann P, Broesamle M, De Graaf J, Bratina N, Tillmann V, Pereira AM, Hiort O. Access to patient oriented information-a baseline Endo-ERN survey among patients with rare endocrine disorders. Endocrine 2021; 71:542-548. [PMID: 33599944 PMCID: PMC8016814 DOI: 10.1007/s12020-021-02654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/29/2021] [Indexed: 12/04/2022]
Abstract
AIM To perform a baseline survey on condition-specific information access among patients/parents/caregivers with rare endocrine disorders (RD) in Europe. METHODS Electronic invitation to participate in a survey (19 questions) was sent to 120 patient advocacy groups (PAGs), and further distributed to 32 European countries. RESULTS A total of 1138 respondents from 22 countries (74% women), aged between 1 year (parents) and 70 years, participated. The Netherlands, France, Germany, Italy and France had highest participation rates. All Main Thematic Groups (MTGs) were represented; the adrenal (32%), pituitary (26%) and thyroid (22%) were the most common. The majority of the respondents got information from their endocrinologist (75%), PAGs (37%) and expert reference centre (22%); 95% received information in their mother tongue. Leaflets (70%), infographics (65%), webinars (60%) and Internet films (55%) were preferred ways of learning. Respondents relied mostly on materials by PAGs and alliances (79%), rather than from specific international RD sites (15%). Fifty-six percent used Facebook, and 37% other social media, with a significant age difference (<40/>40 years) among non-users, 19% vs. 36%, p < 0.0001. Of all, 685 answered questions on informational materials for children-79% wanted materials that can be used by the children themselves. There was significant age difference (<40 years/>40 years) in the willingness to help create new educational materials; 49% vs. 34%, p < 0.001. CONCLUSIONS Our current patient information access survey provides a sound basis for further planning and execution of educational and teaching activities by Endo-ERN.
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Affiliation(s)
- Violeta Iotova
- Endo-ERN Work Package 'Education & Training' Paediatric Chair; Deptartment of Pediatrics, Medical University of Varna, 55"M. Drinov" Str, 9002, Varna, Bulgaria.
| | - Camilla Schalin-Jäntti
- Endo-ERN Work Package 'Education & Training' Adult Chair; Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Bruegmann
- Endo-ERN Work Package 'Education & Training' European Patient Advocacy Group (ePAG) representative co-chair, Endo-ERN, Leiden, The Netherlands
| | - Manuela Broesamle
- Endo-ERN Work Package 'Education & Training' European Patient Advocacy Group (ePAG) representative co-chair, Endo-ERN, Leiden, The Netherlands
| | - Johan De Graaf
- Endo-ERN Work Package 'Education & Training' European Patient Advocacy Group (ePAG) representative co-chair, Endo-ERN, Leiden, The Netherlands
| | - Natasa Bratina
- Department of Endocrinology, Diabetes and Metabolic disorders, University Medical Center, University Childrens Hospital, Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia
| | - Vallo Tillmann
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Alberto M Pereira
- Adult Chair and coordinator of Endo-ERN, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf Hiort
- Paediatric Chair and deputy coordinator of Endo-ERN, Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
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15
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McMullan J, Crowe AL, Bailie C, Moore K, McMullan LS, Shamandi N, McAneney H, McKnight AJ. Improvements needed to support people living and working with a rare disease in Northern Ireland: current rare disease support perceived as inadequate. Orphanet J Rare Dis 2020; 15:315. [PMID: 33168042 PMCID: PMC7649905 DOI: 10.1186/s13023-020-01559-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many people living and working with rare diseases describe consistent difficulties accessing appropriate information and support. In this study an evaluation of the awareness of rare diseases, alongside related information and educational resources available for patients, their families and healthcare professionals, was conducted in 2018-2019 using an online survey and semi-structured interviews with rare disease collaborative groups (charities, voluntary and community groups) active across Northern Ireland (NI). METHODS This study had 2 stages. Stage 1 was an online survey and stage 2 involved semi-structured interviews both with rare disease collaborative groups in Northern Ireland. The surveys and interviews were used to locate existing resources as well as identify gaps where the development of further resources would be appropriate. RESULTS Ninety-nine rare disease collaborative groups engaged with the survey with 31 providing detailed answers. Resources such as information, communication, 'registries', online services, training and improvements to support services were queried. Excellent communication is an important factor in delivering good rare disease support. Training for health professionals was also highlighted as an essential element of improving support for those with a rare disease to ensure they approach people with these unique and challenging diseases in an appropriate way. Carers were mentioned several times throughout the study; it is often felt they are overlooked in rare disease research and more support should be in place for them. Current care/support for those with a rare disease was highlighted as inadequate. Nine semi-structured interviews were conducted with rare disease collaborative groups. Reoccurring themes included a need for more effective information and communication, training for health professionals, online presence, support for carers, and involvement in research. CONCLUSIONS All rare disease collaborative groups agreed that current services for people living and working with a rare disease are not adequate. An important finding to consider in future research within the rare disease field is the inclusion of carers perceptions and experiences in studies. This research provides insight into the support available for rare diseases across Northern Ireland, highlights unmet needs, and suggests approaches to improve rare disease support.
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Affiliation(s)
- Julie McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Ashleen L Crowe
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Caitlin Bailie
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Kerry Moore
- Northern Ireland Rare Disease Partnership, 2 William Street, Newtownards, BT23 4AH, UK
| | - Lauren S McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Nahid Shamandi
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
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16
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Dwyer AA, Au MG, Smith N, Plummer L, Lippincott MF, Balasubramanian R, Seminara SB. Evaluating co-created patient-facing materials to increase understanding of genetic test results. J Genet Couns 2020; 30:598-605. [PMID: 33098367 DOI: 10.1002/jgc4.1348] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
Patients often have difficulty understanding genetic test reports. Technical language and jargon can impede comprehension and limit patients using results to act on findings. One potential way to improve patient understanding of genetic test reports is to provide patient-facing materials. This study aimed to examine understandability and actionability of co-created patient-facing materials for genetic test results in a research context. We combined interprofessional perspectives and patient engagement to co-create patient-facing materials for patients undergoing research genetic testing for congenital hypogonadotropic hypogonadism (Kallmann syndrome). The iterative development process was guided by principles of health literacy and human-centered design (i.e., design thinking). Readability was assessed using eight validated algorithms. Patients and parents evaluated materials using a web-based survey. The gold standard Patient Education Materials Assessment Tool for print materials (PEMAT-P) was employed to measure understandability (content, style, use of numbers, organization, design, use of visual aids) and actionability. PEMAT-P scores >80% were considered high quality. Results were analyzed descriptively and correlations performed to identify relationships between education/health literacy and PEMAT-P ratings. A consensus score of eight algorithms indicated the materials were an 8th -9th grade reading level. Our findings are consistent with the U.S. Department of Health and Human Services 'average difficulty' classification (i.e., 7th-9th grade). In total, 61 patients/parents evaluated the materials. 'Visual Aids' received the lowest mean PEMAT-P rating (89%). All other parameters scored 90%-97%. PEMAT-P scores did not differ according to educational attainment (less than college vs. college or more, p = 0.28). Participants with adequate health literacy were more likely to approve of the 'organization' of information (p < 0.05). Respondents with low health literacy had more favorable views of 'visual aids' (p < 0.01). Involving patients in a co-creation process can produce high-quality patient-facing materials that are easier to understand.
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Affiliation(s)
- Andrew A Dwyer
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA.,Harvard Reproductive Endocrine Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret G Au
- Division of Genetics and Metabolism, University of Kentucky Children's Hospital, Lexington, KY, USA
| | - Neil Smith
- International Patient Support Group for Hypogonadotropic Hypogonadism (HYPOHH), London, UK
| | - Lacey Plummer
- Harvard Reproductive Endocrine Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret F Lippincott
- Harvard Reproductive Endocrine Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ravikumar Balasubramanian
- Harvard Reproductive Endocrine Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie B Seminara
- Harvard Reproductive Endocrine Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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17
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Quinn L, Davis K, Yee A, Snyder H. Understanding genetic learning needs of people affected by rare disease. J Genet Couns 2020; 29:1050-1058. [PMID: 32128950 DOI: 10.1002/jgc4.1233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022]
Abstract
Nearly 350 million people worldwide are affected by a rare disease (RD) and ~80% of RDs have a genetic type, underscoring the need for access to reliable genomics education. Patient assistance in resource development can help ensure content is appropriate. The aim of this study was to define the needs and practical usage of the RD community to inform the scope and content of an online genetic course targeted toward the entire RD ecosystem. A high-level online survey (OS) was disseminated to 586 RD patients and family members/caregivers. A total of 251 individuals responded to the OS. Eight respondents were invited to participate in a follow-up focus group (FG). Nearly 87% of OS respondents have made efforts previously to learn more about genetics and 95.6% indicated a current interest in genetic education. Navigating healthcare systems, information sharing, and advocacy support were driving factors for this desire. Respondents indicated difficulty finding information on gene function, genetic testing, disease pathogenesis, and scientific advances. FG outcomes dove deeper into psychological needs including reducing emotional burden, alleviating fear of the unknown and seeking hope. Research identified high levels of interest in genetic education across all stages of the RD journey. Key themes identified in this study may help guide genetic counselors as they create their own patient and family-facing content.
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Affiliation(s)
| | - Kendall Davis
- Patient Advocacy, PRA Health Sciences Center for Rare Diseases, Pittsburgh, PA, USA
| | - Ashley Yee
- Patient Engagement, Global Genes, Aliso Viejo, CA, USA
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18
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Baldelli I, Gallo F, Crimi M, Fregatti P, Mellini L, Santi P, Ciliberti R. Experiences of patients with Poland syndrome of diagnosis and care in Italy: a pilot survey. Orphanet J Rare Dis 2019; 14:269. [PMID: 31753026 PMCID: PMC6873522 DOI: 10.1186/s13023-019-1253-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Poland Syndrome (PS) is a rare congenital malformation involving functional and aesthetic impairments. Early diagnosis and timely therapeutic approaches play an important role in improving the quality of life of patients and kindred. This study aims to explore healthcare experiences of the diagnosis of patients affected by PS and to investigate the factors associated with diagnostic delay in Italy. RESULTS Seventy-two patients affected by PS were asked to fill in a self- administered questionnaire on: a) diagnostic path; b) perceived quality of care received after diagnosis; c) knowledge of the rights and the socio-economic hardships related to their disease; d) evaluation of the integration of various professional skills involved in the diagnostic and therapeutic approach; e) perception of the social support provided by the Italian Association of Poland Syndrome (AISP). The average age at diagnosis was around 14 years; diagnosis was made at birth in only 31.58% of cases. Although typical symptomatology had appeared on average at an early age (4 months), only 23 patients (40.35%) received an early diagnosis (within the first year of life). Just over half of the patients (n = 30) were diagnosed in their region of origin, while 27 were diagnosed elsewhere. Furthermore, 12.28% were self-diagnoses. Among the patients who were diagnosed outside their region, 15 (88.24%) stated they had foregone some visits or treatments owing to costs and/or organizational issues. CONCLUSIONS An analysis of the patients' experiences highlights several gaps and a lack of homogeneity in the diagnostic and therapeutic follow-up of PS patients in Italy. A specific national diagnostic and therapeutic path is essential to guarantee patients complete and appropriate health services, compliant with the ethical principles of non-discrimination, justice and empathy. Implementation of an effective information and research network and empowerment of patients' associations are necessary conditions to encourage clinical collaboration and improve the quality of life of people living with rare diseases.
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Affiliation(s)
- Ilaria Baldelli
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy. .,Policlinico San Martino Hospital IRCCS for Oncology, L.go R. Benzi 10, 16132, Genoa, Italy. .,Executive Committee Italian Association of Poland Syndrome (AISP), Genoa, Italy. .,Scientific Committee Italian Association of Poland Syndrome (AISP), Genoa, Italy.
| | - Fabio Gallo
- Policlinico San Martino Hospital IRCCS for Oncology, L.go R. Benzi 10, 16132, Genoa, Italy.,Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Marco Crimi
- Kaleidos SCS-Onlus, Scientific Office, Bergamo, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Policlinico San Martino Hospital IRCCS for Oncology, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Lorenzo Mellini
- Executive Committee Italian Association of Poland Syndrome (AISP), Genoa, Italy
| | - Pierluigi Santi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Policlinico San Martino Hospital IRCCS for Oncology, L.go R. Benzi 10, 16132, Genoa, Italy.,Scientific Committee Italian Association of Poland Syndrome (AISP), Genoa, Italy
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19
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Hiort O, Cools M, Springer A, McElreavey K, Greenfield A, Wudy SA, Kulle A, Ahmed SF, Dessens A, Balsamo A, Maghnie M, Bonomi M, Dattani M, Persani L, Audi L. Addressing gaps in care of people with conditions affecting sex development and maturation. Nat Rev Endocrinol 2019; 15:615-622. [PMID: 31406344 DOI: 10.1038/s41574-019-0238-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
Differences of sex development are conditions with discrepancies between chromosomal, gonadal and phenotypic sex. In congenital hypogonadotropic hypogonadism, a lack of gonadotropin activity results primarily in the absence of pubertal development with prenatal sex development being (almost) unaffected in most patients. To expedite progress in the care of people affected by differences of sex development and congenital hypogonadotropic hypogonadism, the European Union has funded a number of scientific networks. Two Actions of the Cooperation of Science and Technology (COST) programmes - DSDnet (BM1303) and GnRH Network (BM1105) - provided the framework for ground-breaking research and allowed the development of position papers on diagnostic procedures and special laboratory analyses as well as clinical management. Both Actions developed educational programmes to increase expertise and promote interest in this area of science and medicine. In this Perspective article, we discuss the success of the COST Actions DSDnet and GnRH Network and the European Reference Network for Rare Endocrine Conditions (Endo-ERN), and provide recommendations for future research.
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Affiliation(s)
- Olaf Hiort
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck and University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Martine Cools
- Department of Paediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Alexander Springer
- Department of Paediatric Surgery, Interdisciplinary Centre for Paediatric Urology, Medical University of Vienna, Vienna, Austria
| | - Ken McElreavey
- Human Developmental Genetics, Department of Developmental and Stem Cell Biology, Institut Pasteur, Paris, France
| | - Andy Greenfield
- Mammalian Genetics Unit, MRC Harwell Institute, Oxfordshire, UK
| | - Stefan A Wudy
- Centre for Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Alexandra Kulle
- Division of Paediatric Endocrinology and Diabetes, Christian-Albrechts-University Kiel & University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Arianne Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Centre - Sophia, Rotterdam, The Netherlands
| | - Antonio Balsamo
- Paediatric Endocrinology Unit, External Consultant of the Reference Centre for Rare Endocrine Conditions, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mohamad Maghnie
- Department of Paediatrics, IRCCS, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Marco Bonomi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Division of Endocrine and Metabolic Diseases, Milan, Italy
| | - Mehul Dattani
- Molecular Basis of Rare Disease Section, Genetics and Genomic Medicine Programme, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Division of Endocrine and Metabolic Diseases, Milan, Italy
| | - Laura Audi
- Growth and Development Research Unit, Vall d'Hebron Research Institute (VHIR), Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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20
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Using rare diseases as teaching models to increase awareness. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:99-100. [PMID: 31201128 DOI: 10.1016/j.oooo.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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21
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Bashir NY, Moore JE, Buckland D, Rodrigues M, Tonelli M, Thombs BD, Bell NR, Isaranuwatchai W, Peng T, Shilman DM, Straus SE. Are patient education materials about cancer screening more effective when co-created with patients? A qualitative interview study and randomized controlled trial. ACTA ACUST UNITED AC 2019; 26:124-136. [PMID: 31043815 DOI: 10.3747/co.26.4621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patient education materials (pems) are frequently used to help patients make cancer screening decisions. However, because pems are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening pem, and we compared how the co-created pem and a pem developed by experts affected decisional conflict and screening intention in patients. Methods We identified and used patient barriers to pca screening to co-create a pca screening pem with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created pem (intervention) or an expert-created pem (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation. Results Of 287 participants randomized to exposure to the co-created pem, 230 were analyzed, and of 287 randomized to exposure to the expert-created pem, 223 were analyzed. After pem exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (ci): -2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk-benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% ci: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% ci: -0.06 to 0.24]). Conclusions The effectiveness of the co-created pem did not differ from that of the pem developed by experts. Thus, pem developers should choose the method that best fits their goals and resources.
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Affiliation(s)
- N Y Bashir
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - J E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - D Buckland
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Rodrigues
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - B D Thombs
- Lady Davis Institute, Sir Mortimer B. Davis Jewish General Hospital, and McGill University, Montreal, QC
| | - N R Bell
- Department of Family Medicine, University of Alberta, Edmonton, AB
| | - W Isaranuwatchai
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - T Peng
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - D M Shilman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - S E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
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22
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Dwyer AA, Smith N, Quinton R. Psychological Aspects of Congenital Hypogonadotropic Hypogonadism. Front Endocrinol (Lausanne) 2019; 10:353. [PMID: 31333578 PMCID: PMC6624645 DOI: 10.3389/fendo.2019.00353] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/17/2019] [Indexed: 12/12/2022] Open
Abstract
Congenital hypogonadotropic hypogonadism/Kallmann syndrome (CHH/KS) is a rare, treatable form of infertility. Like other rare disease patients, individuals with CHH/KS frequently experience feelings of isolation, shame, and alienation. Unlike many rare diseases, CHH/KS is not life threatening and effective treatments are available. Nevertheless, it remains a profoundly life-altering condition with psychosocial distress on a par with untreatable or life-limiting disease. Patients with CHH/KS frequently express lasting adverse psychological, emotional, social, and psychosexual effects resulting from disrupted puberty. They also frequently experience a "diagnostic odyssey," characterized by distressing and convoluted medical referral pathways, lack-of-information, misinformation, and sometimes-incorrect diagnoses. Unnecessary delays in diagnosis and treatment-initiation can significantly contribute to poor body image and self-esteem. Such experiences can erode confidence and trust in medical professionals as well as undermine long-term adherence to treatment-with negative sequelae on health and wellbeing. This review provides a summary of the psychological aspects of CHH/KS and outlines an approach to comprehensive care that spans medical management as well as appropriate attention, care and referrals to peer-to-peer support and mental health services to ameliorate the psychological aspects of CHH/KS.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Andrew A. Dwyer
| | - Neil Smith
- International Patient Support Group for Hypogonadotropic Hypogonadism (HYPOHH), London, United Kingdom
| | - Richard Quinton
- Newcastle-upon-Tyne Hospitals Foundation NHS Trust (Royal Victoria Infirmary) and Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom
- Richard Quinton
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23
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Young A, Menon D, Street J, Al-Hertani W, Stafinski T. Exploring patient and family involvement in the lifecycle of an orphan drug: a scoping review. Orphanet J Rare Dis 2017; 12:188. [PMID: 29273068 PMCID: PMC5741909 DOI: 10.1186/s13023-017-0738-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i.e., orphan drug lifecycle). METHODS A scoping review was conducted using methods outlined by Arksey and O'Malley. To validate the findings from the literature and identify any additional opportunities that were missed, a consultative webinar was conducted with members of the Patient and Caregiver Liaison Group of a Canadian research network. RESULTS Existing and proposed opportunities for involving patients, families, and patient organizations were reported throughout the orphan drug lifecycle and fell into 12 themes: research outside of clinical trials; clinical trials; patient reported outcomes measures; patient registries and biorepositories; education; advocacy and awareness; conferences and workshops; patient care and support; patient organization development; regulatory decision-making; and reimbursement decision-making. Existing opportunities were not described in sufficient detail to allow for the level of involvement to be assessed. Additionally, no information on the impact of involvement within specific opportunities was found. Based on feedback from patients and families, documentation of existing opportunities within Canada is poor. CONCLUSIONS Opportunities for patient, family, and patient organization involvement exist throughout the orphan drug lifecycle. However, based on the information found, it is not possible to determine which opportunities would be most effective at each stage.
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Affiliation(s)
- Andrea Young
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Jackie Street
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Walla Al-Hertani
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
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de Freitas C, dos Reis V, Silva S, Videira PA, Morava E, Jaeken J. Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation. BMC Health Serv Res 2017; 17:682. [PMID: 28950866 PMCID: PMC5615629 DOI: 10.1186/s12913-017-2625-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. METHODS Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. RESULTS The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. CONCLUSION This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients' clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed.
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Affiliation(s)
- Cláudia de Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
- Centre for Research and Studies in Sociology - University Institute of Lisbon, Porto, Portugal
- Institutional address 2: Avenida das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Vanessa dos Reis
- Founder of the Portuguese Association for CDG (APCDG), Porto, Portugal
- Institutional address: Rua Manuel da Fonseca 46, 2820-389, Almada, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Paula A. Videira
- Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
- Institutional address: Glycoimmunology group Lab 3.19 - Departamento Ciências da Vida (Ed Departamental), Faculdade de Ciências e Tecnologia, 2829-516 Caparica, Portugal
| | - Eva Morava
- School of Medicine, Tulane University, New Orleans, USA
- Institutional address: Hayward Genetics Center SL#31, Tulane University Medical School, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Jaak Jaeken
- Department of Pediatrics, Center for Metabolic Disease, University Hospital Gasthuisberg, Leuven, Belgium
- Institutional Address: Herestraat 49, 3000, Leuven, Belgium
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