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Bushweller L, Hodges S, Meyer L, Reed J, Saunders K, Jenkins R, Berg KA, Thornton JD, Ribeiro Neto ML, Culver DA, Harper LJ. Partnering With Patients With Sarcoidosis to Implement a Community Advisory Board. Chest 2024; 166:343-351. [PMID: 38369254 PMCID: PMC11317805 DOI: 10.1016/j.chest.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Community advisory boards (CABs) are increasingly recognized as a means of incorporating patient experience into clinical practice and research. The power of CABs is derived from engaging with community members as equals throughout the research process. Despite this, little is known of community member experience and views on best practices for running a CAB in a rare pulmonary disease. RESEARCH QUESTION What are CAB members' views on the best practices for CAB formation and maintenance in a rare pulmonary disease? STUDY DESIGN AND METHODS In August 2021, we formed the Cleveland Clinic Sarcoidosis Health Partners (CC-HP) as a CAB to direct research and clinic improvement initiatives at a quaternary sarcoidosis center. We collaboratively evaluated our process for formation and maintenance of the CC-HP with the patient members of the group. Through the series of reflection/debriefing discussions, CAB patient members developed a consensus account of salient obstacles and facilitators of forming and maintaining a CAB in a rare pulmonary disease. RESULTS Clinician and community members of the CC-HP found published guidelines to be an effective tool for structuring formation of a CAB in a rare pulmonary disease. Facilitators included a dedicated coordinator, collaborative development of projects, and a focus on improving clinical care. Obstacles to CAB functioning were formal structure, focus on projects with academic merit but no immediate impact to patients, and overreliance on digital resources. INTERPRETATION By centering our evaluation of our CAB on community member experience, we were able to both identify facilitators and impediments to CAB as well as improve our own processes.
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Affiliation(s)
| | - Sandra Hodges
- Cleveland Clinic Sarcoidosis Center Health Partners Council-Patient Members, Cleveland, OH
| | - Linda Meyer
- Cleveland Clinic Sarcoidosis Center Health Partners Council-Patient Members, Cleveland, OH
| | - Johnie Reed
- Cleveland Clinic Sarcoidosis Center Health Partners Council-Patient Members, Cleveland, OH
| | - Karen Saunders
- Cleveland Clinic Sarcoidosis Center Health Partners Council-Patient Members, Cleveland, OH
| | | | - Kristen A Berg
- Center for Health Care Research & Policy, Population Health Equity Research Institute, MetroHealth Medical System, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland OH
| | - J Daryl Thornton
- Center for Health Equity Engagement Education and Research, the MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health and Equity Research Institute, the MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
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Harrison J, Balkan E, Bernard KP, Gadbois EA, Thomas KS. A protocol for stakeholder engagement in deliver-EE: A pragmatic randomized comparative effectiveness trial evaluating effects of meal delivery on the ability of homebound older adults to remain in the community. Contemp Clin Trials 2024; 141:107535. [PMID: 38614446 DOI: 10.1016/j.cct.2024.107535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Few clinical trials include a detailed protocol for stakeholder engagement in the design and execution of the clinical trial. Deliver-EE is a pragmatic clinical trial to assess how different types of home-delivered meals can affect older adults' health and well-being. We present the protocol for stakeholder engagement in this national, multi-site trial and initial findings from our efforts. METHODS Twenty-nine participants were recruited to two stakeholder advisory panels. The "Lived Experience Perspectives" panel is defined as the clients, caregivers, and meal delivery drivers with first-hand knowledge and lived experiences with meal delivery. The "System Perspectives" panel is defined as representatives from the larger financial, clinical, regulatory, and operational environments in which meal delivery to homebound older adults operate. Together, these two groups holistically represent interested parties that coordinate the interdependent elements of meal delivery to homebound older adults in order to: 1) inform our understanding of what matters most to older adults, their families, and the larger health and social care systems; 2) provide strategies to overcome challenges conducting the study; 3) enhance dissemination and uptake of study findings; and 4) identify opportunities for future research. RESULTS Although stakeholder partners share a common goal of using home-delivered meals as a method to improve outcomes for homebound older adults, individuals have different goals for participating as advisors in this research. CONCLUSIONS Understanding what individual stakeholders hope to gain from their participation is critical in designing an effective engagement protocol and critical for meaningful and rigorous stakeholder engagement in clinical trials.
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Affiliation(s)
- Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
| | - Em Balkan
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Kimberly P Bernard
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Emily A Gadbois
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Kali S Thomas
- Johns Hopkins, School of Nursing, Baltimore, MD, USA
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Zhao N, Cuthel AM, Storms O, Zhang R, Yamarik RL, Hill J, Kaur R, Van Allen K, Flannery M, Chang A, Chung F, Randhawa S, Alvarez IC, Young-Brinn A, Kizzie-Gillett CL, Rosini D, Isaacs ED, Hopkins E, Chan GK, Booker-Vaughns J, Maguire M, Navarro M, Pidatala NR, Dunn P, Williams P, Galvin R, Batra R, Welsh S, Vaughan W, Bouillon-Minois JB, Grudzen CR. Advancing patient-centered research practices in a pragmatic patient-level randomized clinical trial: A thematic analysis of stakeholder engagement in Emergency Medicine Palliative Care Access (EMPallA). RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:10. [PMID: 38263088 PMCID: PMC10807180 DOI: 10.1186/s40900-023-00539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Involving patient and community stakeholders in clinical trials adds value by ensuring research prioritizes patient goals both in conduct of the study and application of the research. The use of stakeholder committees and their impact on the conduct of a multicenter clinical trial have been underreported clinically and academically. The aim of this study is to describe how Study Advisory Committee (SAC) recommendations were implemented throughout the Emergency Medicine Palliative Care Access (EMPallA) trial. EMPallA is a multi-center, pragmatic two-arm randomized controlled trial (RCT) comparing the effectiveness of nurse-led telephonic case management and specialty, outpatient palliative care of older adults with advanced illness. METHODS A SAC consisting of 18 individuals, including patients with palliative care experience, members of healthcare organizations, and payers was convened for the EMPallA trial. The SAC engaged in community-based participatory research and assisted in all aspects from study design to dissemination. The SAC met with the research team quarterly and annually from project inception to dissemination. Using meeting notes and recordings we completed a qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize SAC recommendations throughout the project's duration. RESULTS The SAC convened 16 times between 2017 and 2020. Over the course of the project, the SAC provided 41 unique recommendations. Twenty-six of the 41 (63%) recommendations were adapted into formal Institutional Review Board (IRB) study modifications. Recommendations were coded into four major themes: Scientific, Pragmatic, Resource and Dissemination. A majority of the recommendations were related to either the Scientific (46%) or Pragmatic (29%) themes. Recommendations were not mutually exclusive across three study phases: Preparatory, execution and translational. A vast majority (94%) of the recommendations made were related to the execution phase. Major IRB study modifications were made based on their recommendations including data collection of novel dependent variables and expanding recruitment to Spanish-speaking patients. CONCLUSIONS Our study provides an example of successful integration of a SAC in the conduct of a pragmatic, multi-center RCT. Future trials should engage with SACs in all study phases to ensure trials are relevant, inclusive, patient-focused, and attentive to gaps between health care and patient and family needs. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03325985, 10/30/2017.
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Affiliation(s)
- Nicole Zhao
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
| | - Owen Storms
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Raina Zhang
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | | | - Jacob Hill
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
- Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Regina Kaur
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Kaitlyn Van Allen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Alex Chang
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Frank Chung
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Sumeet Randhawa
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Isabel Castro Alvarez
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Angela Young-Brinn
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Dawn Rosini
- University of Florida Shands Hospital, Gainesville, FL, USA
- The University of Florida College of Medicine, Gainesville, FL, USA
| | - Eric D Isaacs
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Martha Navarro
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | | | - Pluscedia Williams
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- The Lundquist Institute/Harbor-UCLA Medical Center, Torrence, CA, USA
| | | | - Romilla Batra
- Senior Care Action Network (SCAN) Health Plan, Long Beach, CA, USA
| | - Sally Welsh
- Hospice and Palliative Nurses Association, Carnegie, PA, USA
| | | | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
- Emergency Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Corita R Grudzen
- Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ballengee LA, King HA, Simon C, Lentz TA, Allen KD, Stanwyck C, Gladney M, George SZ, Hastings SN. Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial. Clin Trials 2023; 20:463-472. [PMID: 37269070 PMCID: PMC10524642 DOI: 10.1177/17407745231178789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Embedded pragmatic clinical trials are increasingly recommended for non-pharmacological pain care research due to their focus on examining intervention effectiveness within real-world settings. Engagement with patients, health care providers, and other partners is essential, yet there is limited guidance for how to use engagement to meaningfully inform the design of interventions to be tested in pain-related pragmatic clinical trials. This manuscript aims to describe the process and impacts of partner input on the design of two interventions (care pathways) for low back pain currently being tested in an embedded pragmatic trial in the Veterans Affairs health care system. METHODS Sequential cohort design for intervention development was followed. Engagement activities were conducted with 25 participants between November 2017 and June 2018. Participants included representatives from multiple groups: clinicians, administrative leadership, patients, and caregivers. RESULTS Partner feedback led to several changes in each of the care pathways to improve patient experience and usability. Major changes to the sequenced care pathway included transitioning from telephone-based delivery to a flexible telehealth model, increased specificity about pain modulation activities, and reduction of physical therapy visits. Major changes to the pain navigator pathway included transitioning from a traditional stepped care model to one that offers care in a feedback loop, increased flexibility regarding pain navigator provider type, and increased specificity for patient discharge criteria. Centering patient experience emerged as a key consideration from all partner groups. CONCLUSION Diverse input is important to consider before implementing new interventions in embedded pragmatic trials. Partner engagement can increase acceptability of new care pathways to patients and providers and enhance uptake of effective interventions by health systems. TRIAL REGISTRATION NCT#04411420. Registered on 2 June 2020.
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Affiliation(s)
- Lindsay A Ballengee
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Corey Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Stanwyck
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Micaela Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Steven Z George
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
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