1
|
Ahmad T, Schreyer L, Fung R, Yu C. Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study. PLoS One 2024; 19:e0301603. [PMID: 38768242 PMCID: PMC11104599 DOI: 10.1371/journal.pone.0301603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs. METHODS We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round. FINDINGS In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion. CONCLUSIONS To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.
Collapse
Affiliation(s)
- Tehmina Ahmad
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Leighton Schreyer
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raymond Fung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, East York, ON, Canada
| | - Catherine Yu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| |
Collapse
|
2
|
Spronk I, van Uden D, Lansdorp CA, van Dammen L, van Gemert R, Visser I, Versluis G, Wanders H, Geelen SJG, Verwilligen RAF, van der Vlegel M, Bijker GC, Heijblom MC, Fokke-Akkerman M, Stoop M, van Baar ME, Nieuwenhuis MK, Pijpe A, van Schie CMH, Gardien KLM, Lucas Y, Snoeks A, Scholten-Jaegers SMHJ, Meij-de Vries A, Haanstra TM, Weel-Koenders AEAM, Wood FM, Edgar DW, Bosma E, Middelkoop E, van der Vlies CH, van Zuijlen PPM. Development of a value-based healthcare burns core set for adult burn care. Burns 2024:S0305-4179(24)00116-5. [PMID: 38902131 DOI: 10.1016/j.burns.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. METHODS A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item 'important'. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. RESULTS Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. CONCLUSION A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.
Collapse
Affiliation(s)
- I Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands.
| | - D van Uden
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - C A Lansdorp
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
| | - L van Dammen
- Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Burn Centre, Martini Hospital, Groningen, the Netherlands
| | | | - I Visser
- Dutch Association of Burn survivors
| | - G Versluis
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Dutch Association of Burn survivors
| | | | - S J G Geelen
- Burn Centre, Martini Hospital, Groningen, the Netherlands; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | | | - M van der Vlegel
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - G C Bijker
- Burn Centre, Martini Hospital, Groningen, the Netherlands
| | - M C Heijblom
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Fokke-Akkerman
- Association of Dutch Burn Centres (ADBC), Martini Hospital, Groningen, the Netherlands
| | - M Stoop
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - M E van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands
| | - M K Nieuwenhuis
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; Association of Dutch Burn Centres (ADBC), Martini Hospital, Groningen, the Netherlands; Department for Human Movement Sciences, University Medical Center Groningen, University of Groningen, the Netherlands
| | - A Pijpe
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - K L M Gardien
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - Y Lucas
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - A Snoeks
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | | | - A Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - T M Haanstra
- Dutch Burns Foundation, Beverwijk, the Netherlands; Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - A E A M Weel-Koenders
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Maasstad Hospital, Rotterdam, the Netherlands
| | - F M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia
| | - D W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia; Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia
| | - E Bosma
- Burn Centre, Martini Hospital, Groningen, the Netherlands; Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - E Middelkoop
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - C H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit, Department of Surgery, the Netherlands
| | - P P M van Zuijlen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| |
Collapse
|
3
|
Décary S, de Wit M, Naye F, Barton JL, Fraenkel L, Li LC, Brooks P, Stacey D, Maxwell LJ, Campbell W, Hofstetter C, Voshaar M, Meara A, Christensen R, Boonen A, Suarez-Almazor ME, Meade T, March L, Jull JE, Alten R, Morgan EM, Stewart Hazlewood G, Barber CEH, Guillemin F, El-Miedany Y, Mittoo S, Robertson TW, Bartlett SJ, Singh JA, Mannion M, Nasef SI, Boel A, Adebajo A, Arnaud L, Gill TK, Moholt E, Burt J, Jayatilleke A, Hmamouchi I, Berthelsen DB, Blanco FJ, Mather K, Maharaj A, Sharma S, Caso F, Beaton D, Shea B, Fong C, Fernandez AP, Mackie S, Nikiphorou E, Jones A, Greer-Smith R, Sloan VS, Akpabio A, Strand V, Lee RR, Umaefulam V, Monti S, Abaza N, Schultz G, Stones S, Gossec L, Nielsen SM, Cavallo S, Srinivasalu H, Constien D, Evans V, Tugwell P, Toupin-April K. Consensus on the definitions and descriptions of the domains of the OMERACT Core Outcome Set for shared decision making interventions in rheumatology trials. Semin Arthritis Rheum 2024; 65:152381. [PMID: 38306813 DOI: 10.1016/j.semarthrit.2024.152381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To gain consensus on the definitions and descriptions of the domains of the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials evaluating shared decision making (SDM) interventions. METHODS Following the OMERACT Handbook methods, our Working Group (WG), comprised of 90 members, including 17 patient research partners (PRPs) and 73 clinicians and researchers, had six virtual meetings in addition to email exchanges to develop draft definitions and descriptions. The WG then conducted an international survey of its members to gain consensus on the definitions and descriptions. Finally, the WG members had virtual meetings and e-mail exchanges to review survey results and finalize names, definitions and descriptions of the domains. RESULTS WG members contributed to developing the definitions. Fifty-two members representing four continents and 13 countries completed the survey, including 15 PRPs, 33 clinicians and 37 researchers. PRPs and clinicians/researchers agreed with all definitions and descriptions with agreements ranging from 87% to 100%. Respondents suggested wording changes to the names, definitions and descriptions to better reflect the domains. Discussions led to further simplification and clarification to address common questions/concerns about the domains. CONCLUSION Our WG reached consensus on the definitions and descriptions of the domains of the core domain set for rheumatology trials of SDM interventions. This step is crucial to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE The current study provides consensus-based definitions and descriptions for the domains of the OMERACT core domain set for shared decision making interventions from patients/caregivers, clinicians and researchers. This is a crucial step to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set for trials of SDM interventions.
Collapse
Affiliation(s)
- Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia; Arthritis Research Canada, Canada
| | - Peter Brooks
- School of Population and Global Health, University of Melbourne and Northern Health, Melbourne, Australia
| | - Dawn Stacey
- School of Nursing, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, University Health Network, Canada
| | | | - Marieke Voshaar
- Patient Research Partner; Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tanya Meade
- Western Sydney University, Sydney, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital; The University of Sydney, Australia
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington. Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Yasser El-Miedany
- Canterbury Christ Church University, Canterbury; King's College London, London, United Kingdom
| | - Shikha Mittoo
- Vanshavardhana Canada Integrated Health, Toronto, Canada
| | - Tiffany Westrich Robertson
- CEO, Patient research partner, International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis), USA
| | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University; Research Institute, McGill University Health Centre; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | | | - Melissa Mannion
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anne Boel
- Department of Rheumatology, Leiden University Medical Centre; UCB Pharma, B.V. Netherlands, Leiden, the Netherlands
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom
| | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, Strasbourg, France
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Ellen Moholt
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway
| | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain, Spain
| | | | - Ajesh Maharaj
- Department of Internal Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Beverly Shea
- Bruyère Research Institute; Ottawa Hospital Research Institute; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Christopher Fong
- Eastern Clinical Research Unit, Monash University, Melbourne, Australia
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London; Rheumatology Department, King's College Hospital, London, United Kingdom
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Regina Greer-Smith
- Patient Research Partner, President/CEO, Healthcare Research Associates, LLC/S.T.A.R. Initiative; Ambassador, Patient-Centered Outcomes Research Institute, Apple Valley, CA, USA
| | - Victor S Sloan
- Sheng Consulting LLC, Flemington, New Jersey USA; The Peace Corps, Washington, DC, USA
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Valerie Umaefulam
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Nouran Abaza
- Professor of Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Simon Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Laure Gossec
- Professor of Rheumatology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, the Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Denmark
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, University of Montreal; Researcher Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada; Sainte-Justine University Health Center Research Center, Montreal, Canada
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital; GW School of Medicine, Washington, DC, USA
| | - Deb Constien
- Patient Research Partner, Central Regional Lead, Advocacy Leadership Board Chair, International Foundation of Autoimmune Autoinflammatory Arthritis (AiArthritis), Madison, Wisconsin, USA
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa; Department of Pediatrics, Faculty of Medicine, University of Ottawa; Affiliate scientist, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada.
| |
Collapse
|
4
|
Vidyasagaran AL, Ayesha R, Boehnke J, Kirkham J, Rose L, Hurst J, Miranda JJ, Rana RZ, Vedanthan R, Faisal M, Siddiqi N. Core outcome sets for trials of interventions to prevent and to treat multimorbidity in low- and middle-income countries: the COSMOS study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.29.24301589. [PMID: 38352562 PMCID: PMC10863036 DOI: 10.1101/2024.01.29.24301589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Introduction The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. A core outcome set (COS) appropriate for the study of multimorbidity in LMIC contexts does not presently exist. This is required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at the prevention and treatment of multimorbidity in LMICs. Methods To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups with representation from 33 countries (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals, and policy makers). Consensus meetings were used to reach agreement on the two final COS. Registration: https://www.comet-initiative.org/Studies/Details/1580. Results The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention, and six treatment outcomes were added from Delphi round one. Delphi round two surveys were completed by 95 of 132 round one participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) Adverse events, (2) Development of new comorbidity, (3) Health risk behaviour, and (4) Quality of life; and four for the treatment COS: (1) Adherence to treatment, (2) Adverse events, (3) Out-of-pocket expenditure, and (4) Quality of life. Conclusion Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.
Collapse
Affiliation(s)
| | - Rubab Ayesha
- Rawalpindi Medical University; Foundation University School of Science and Technology
| | - Jan Boehnke
- University of Dundee, School of Health Sciences; University of York, Department of Health Sciences
| | - Jamie Kirkham
- The University of Manchester, Centre for Biostatistics; Manchester Academic Health Science Centre
| | - Louise Rose
- King's College London Florence Nightingale Faculty of Nursing Midwifery & Palliative Care
| | - John Hurst
- University College London, Department of Respiratory Medicine
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, CRONICAS Center of Excellence in Chronic Diseases; The George Institute for Global Health
| | | | - Rajesh Vedanthan
- NYU Grossman School of Medicine, Section for Global Health, Department of Population Health
| | | | - Najma Siddiqi
- University of York, Department of Health Sciences; Hull York Medical School
| |
Collapse
|
5
|
Demetri A, Davies A, Bakhbakhi D, Ijaz S, Dawson S, McGuinness S, Beasor G, Clayton G, Johnson A, de Souza C, Dempsey A, Snook G, Sharp A, Lissauer D, McGoldrick E, Burden C, Merriel A. Vaginal birth core information set: study protocol for a Delphi study to achieve a consensus on a 'core information set' for vaginal birth. BMJ Open 2023; 13:e070215. [PMID: 37550021 PMCID: PMC10407363 DOI: 10.1136/bmjopen-2022-070215] [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] [Received: 11/17/2022] [Accepted: 05/05/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Studies have shown that women are often underinformed about potential benefits and risks of vaginal birth. This is in contrast to other modes of birth, such as caesarean birth, for which the risks/benefits are often conveyed prior to undergoing the procedure. A core information set (CIS) is an agreed set of information points that should be discussed with all patients prior to undergoing a procedure or intervention. This CIS could improve the quality of information given regarding mode of birth options, as women will be given information prioritised by patients and stakeholders regarding vaginal birth, empowering them to make informed decisions about their birth. We aim to describe the protocol for the development of this vaginal birth CIS. METHODS AND ANALYSIS We will develop the CIS by: (1) Compiling a 'long-list' of information points about vaginal birth by: undertaking a scoping review of studies and patient information leaflets; interviews with antenatal/postnatal women, an online survey of stakeholders. (2) Collating the 'long-list' of information points and developing the Delphi survey. Think-aloud interviews will refine the survey. (3) Conducting a two-round Delphi survey. 200 stakeholder participants will be recruited. Items rated critically important by ≥80% of participants in one stakeholder group, or with no consensus, will be carried through to a stakeholder consensus meeting to decide the final CIS. Planned start date is 1 June 2022. Planned end date is 31 August 2023. ETHICS AND DISSEMINATION This project has been given a favourable ethics opinion by the University of Bristol Research Ethics Committee (Ref: 10530). Approval from the ethics committee will be sought for any protocol amendments, and the principal investigator will be responsible for these changes. Findings will be presented at relevant conferences and published in a high-impact journal. We will disseminate the CIS, via Policy Bristol, to clinical policy and guideline developers.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Aine Dempsey
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Andrew Sharp
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - David Lissauer
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Abi Merriel
- University of Bristol, Bristol, UK
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
6
|
Perfetto EM, Love TR, Oehrlein EM, Schoch SC, Schrandt S. A Foundation for Patient-Centered Core Impact Sets: Key Learnings from Past and Existing Approaches. THE PATIENT 2023:10.1007/s40271-023-00630-1. [PMID: 37204700 DOI: 10.1007/s40271-023-00630-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/20/2023]
Abstract
Despite growing commitment to patient centricity, challenges persist in consistently identifying the impacts of disease and/or treatment that patients report as most important to them, especially across myriad potential downstream uses. Patient-centered core impact sets (PC-CIS), disease-specific lists of impacts that patients report as most important, are proposed as a solution. But, PC-CIS is a new concept, currently in the pilot stage with patient advocacy groups. We conducted an environmental scan to explore PC-CIS conceptual overlap with past/existing efforts [e.g., core outcome sets (COS)] and to inform general feasibility for further development and operationalization. With guidance and advice from an expert advisory committee, we conducted a search of the literature and relevant websites. Identified resources were reviewed for alignment with the PC-CIS definition, and key insights were gleaned. We identified 51 existing resources and five key insights: (1) no existing efforts identified meet the definition of PC-CIS as we have specified it in terms of patient centricity, (2) existing COS-development efforts are a valuable source of foundational resources for PC-CIS, (3) existing health-outcome taxonomies can be augmented with patient-prioritized impacts to create a comprehensive impact taxonomy, (4) current approaches/methods can inadvertently exclude patient priorities from core lists/sets and will need to be modified to protect the patient voice, and (5) there is need for clarity and transparency on how patients were engaged in individual past/existing efforts. PC-CIS is conceptually unique from past/existing efforts in its explicit emphasis on patient leadership and being patient driven. However, PC-CIS development can leverage many resources from the past/existing related work.
Collapse
Affiliation(s)
| | - T Rosie Love
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | | | | | | |
Collapse
|
7
|
Sullivan DR, Iyer AS, Enguidanos S, Cox CE, Farquhar M, Janssen DJA, Lindell KO, Mularski RA, Smallwood N, Turnbull AE, Wilkinson AM, Courtright KR, Maddocks M, McPherson ML, Thornton JD, Campbell ML, Fasolino TK, Fogelman PM, Gershon L, Gershon T, Hartog C, Luther J, Meier DE, Nelson JE, Rabinowitz E, Rushton CH, Sloan DH, Kross EK, Reinke LF. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022; 206:e44-e69. [PMID: 36112774 PMCID: PMC9799127 DOI: 10.1164/rccm.202207-1262st] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
Collapse
|
8
|
van Zuuren EJ, Logullo P, Price A, Fedorowicz Z, Hughes EL, Gattrell WT. Existing guidance on reporting of consensus methodology: a systematic review to inform ACCORD guideline development. BMJ Open 2022; 12:e065154. [PMID: 36201247 PMCID: PMC9462098 DOI: 10.1136/bmjopen-2022-065154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify evidence on the reporting quality of consensus methodology and to select potential checklist items for the ACcurate COnsensus Reporting Document (ACCORD) project to develop a consensus reporting guideline. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE, Web of Science, PubMed, Cochrane Library, Emcare, Academic Search Premier and PsycINFO from inception until 7 January 2022. ELIGIBILITY CRITERIA Studies, reviews and published guidance addressing the reporting quality of consensus methodology for improvement of health outcomes in biomedicine or clinical practice. Reports of studies using or describing consensus methods but not commenting on their reporting quality were excluded. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Screening and data extraction of eligible studies were carried out independently by two authors. Reporting quality items addressed by the studies were synthesised narratively. RESULTS Eighteen studies were included: five systematic reviews, four narrative reviews, three research papers, three conference abstracts, two research guidance papers and one protocol. The majority of studies indicated that the quality of reporting of consensus methodology could be improved. Commonly addressed items were: consensus panel composition; definition of consensus and the threshold for achieving consensus. Items least addressed were: public patient involvement (PPI); the role of the steering committee, chair, cochair; conflict of interest of panellists and funding. Data extracted from included studies revealed additional items that were not captured in the data extraction form such as justification of deviation from the protocol or incentives to encourage panellist response. CONCLUSION The results of this systematic review confirmed the need for a reporting checklist for consensus methodology and provided a range of potential checklist items to report. The next step in the ACCORD project builds on this systematic review and focuses on reaching consensus on these items to develop the reporting guideline. PROTOCOL REGISTRATION https://osf.io/2rzm9.
Collapse
Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Patricia Logullo
- Nuffield Department of Orthopaedics, Rheumatology and Muskuloskeletal Sciences, Centre for Statistics in Medicine, University of Oxford and EQUATOR Network UK Centre, Oxford, Oxfordshire, UK
| | - Amy Price
- Stanford Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
- The BMJ, London, UK
| | | | | | | |
Collapse
|
9
|
Alanazi SA, Vicenzino B, van Bergen CJA, Hunter DJ, Wikstrom EA, Menz HB, Golightly YM, Smith MD. Protocol for the development of a core domain set for individuals with ankle osteoarthritis. Trials 2022; 23:748. [PMID: 36064628 PMCID: PMC9446870 DOI: 10.1186/s13063-022-06692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ankle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis—an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA. Methods We established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys. Conclusion This protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms. Project registration This project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06692-0.
Collapse
Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia.,Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Amphia, Breda, the Netherlands.,Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne M Golightly
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE, USA.,Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia.
| |
Collapse
|
10
|
Quinn KA, Monti S, Christensen R, Jayne D, Langford CA, Lanier GE, Mahr A, Pagnoux C, Shea B, Viðarsdóttir MB, Tomasson G, Merkel PA. An International Delphi Exercise to Identify Items of Importance for Measuring Response to Treatment in ANCA-Associated Vasculitis. Semin Arthritis Rheum 2022; 55:152021. [PMID: 35523065 PMCID: PMC9262834 DOI: 10.1016/j.semarthrit.2022.152021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE ANCA-associated vasculitis (AAV) is characterized by fluctuating levels of disease activity, but no formal criteria exist to measure response to treatment. This Delphi exercise aimed to reach consensus about which measures are considered by patients and physicians to be most important when assessing response to treatment in clinical trials of AAV. METHODS An international 3-round online Delphi exercise was conducted. Survey participants included patients with AAV and physicians with expertise in AAV. Survey participants were asked to rate (on a scale of 1-9) the importance of each item when assessing response to treatment in AAV. Items scored 7-9 by ≥70% participants were considered highly important. RESULTS 89 patients and 176 physicians completed three rounds of the Delphi exercise. The most highly rated items of response involved disease activity [extent of organ involvement, physician global assessment], mortality [survival], and patient-reported outcomes [patient global assessment and health-related quality of life measures]. Achievement of specific BVAS scores were highly rated only by physicians. Items highly rated only by patients included laboratory measures [changes on urinalysis and acute phase reactants], pain, and fatigue. Additional items related to damage and adverse events were highly rated by both groups. CONCLUSION There is consensus between patients and physicians on many items considered important to measure when assessing response to treatment in AAV. There are some items considered important by only patients or only physicians. These data will inform the next steps in the development criteria of response to treatment in AAV.
Collapse
|
11
|
Chaplin H, Carpenter L, Raz A, Nikiphorou E, Lempp H, Norton S. Summarizing current refractory disease definitions in rheumatoid arthritis and polyarticular juvenile idiopathic arthritis: systematic review. Rheumatology (Oxford) 2021; 60:3540-3552. [PMID: 33710321 PMCID: PMC8328502 DOI: 10.1093/rheumatology/keab237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify how refractory disease (or relevant terminology variations) in RA and polyarticular JIA (polyJIA) is defined and establish the key components of such definitions. METHODS Searches were undertaken of English-language articles within six medical databases, including manual searching, from January 1998 to March 2020 (PROSPERO: CRD42019127142). Articles were included if they incorporated a definition of refractory disease, or non-response, in RA/polyJIA, with clear components to the description. Qualitative content analysis was undertaken to describe refractory disease in RA/polyJIA and classify each component within each definition. RESULTS Of 6251 studies screened, 646 met the inclusion criteria; 581 of these applied non-response criteria while 65 provided refractory disease definitions/descriptions. From the non-response studies, 39 different components included various disease activity measures, emphasizing persistent disease activity and symptoms, despite treatment with one or more biologic DMARD (bDMARD). From papers with clear definitions for refractory disease, 41 components were identified and categorized into three key themes: resistance to multiple drugs with different mechanisms of action, typically two or more bDMARDs; persistence of symptoms and disease activity; and other contributing factors. The most common term used was 'refractory' (80%), while only 16.9% reported explicitly how their definition was generated (e.g. clinical experience or statistical methods). CONCLUSION Refractory disease is defined as resistance to multiple drugs with different mechanisms of action by persistence of physical symptoms and high disease activity, including contributing factors. A clear unifying definition needs implementing, as the plethora of different definitions makes study comparisons and appropriate identification of patients difficult.
Collapse
Affiliation(s)
- Hema Chaplin
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Lewis Carpenter
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anni Raz
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Rheumatic Diseases, King’s College London, London, UK
| |
Collapse
|
12
|
Tieu J, Cheah JT, Black RJ, Christensen R, Ghosh N, Richards P, Robson J, Shea B, Simon LS, Singhi JA, Tugwell P, Boers M, Garibay MAA, Campochiaro C, Decary S, de Witt M, Fernandez AP, Keen HI, King L, Hinojosa-Azaola A, Hofstetter C, Gaydukova I, George MD, Gupta L, Lyne S, Makol A, Mukhtyar C, Oo WM, Petri M, Pisaniello HL, Sattui SE, Russell O, Teixeira V, Toupin-April K, Uhunmwangho C, Whitstock M, Yip K, Mackie SL, Goodman SM, Hill CL. Improving benefit-harm assessment of glucocorticoid therapy incorporating the patient perspective: The OMERACT glucocorticoid core domain set. Semin Arthritis Rheum 2021; 51:1139-1145. [PMID: 34253398 DOI: 10.1016/j.semarthrit.2021.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our primary objective was to develop an Outcome Measures in Rheumatology (OMERACT) core domain set to capture the impact of glucocorticoids (GC), both positive and negative, on patients with Rheumatic conditions. METHODS The OMERACT Filter 2.1 was used to guide core domain selection. Systematic literature reviews, qualitative studies and quantitative surveys were conducted by the OMERACT GC Impact working group to identify candidate domains for a core domain set. A summary of prior work and Delphi exercise were presented at the OMERACT 2020 virtual GC workshop. A proposed GC Impact core domain set derived from this work was presented for discussion in facilitated breakout groups. Participants voted on the proposed GC Impact core domain set. RESULTS 113 people, including 23 patient research partners, participated in two virtual workshops conducted at different times on the same day. The proposed mandatory domains to be evaluated in clinical trials involving GCs were: infection, bone fragility, hypertension, diabetes, weight, fatigue, mood disturbance and death. In addition, collection of disease specific outcomes was included in the core domain set as "mandatory in specific circumstances". The proposed core domain set was endorsed by 100% (23/23) of the patient research partners and 92% (83/90) of the remaining participants, including clinicians, researchers and industry stakeholders. CONCLUSION A GC Impact core domain set was endorsed at the OMERACT 2020 virtual workshop. The OMERACT GC Impact working group will now progress to identify, develop and validate measurement tools to best address these domains in clinical trials.
Collapse
Affiliation(s)
- Joanna Tieu
- Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Unit, Lyell McEwin Hospital, Adelaide, Australia, Adelaide, Australia
| | - Jonathan Tl Cheah
- Division of Rheumatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA, Division of Rheumatology, UMass Memorial Health Care, Worcester, MA, USA
| | - Rachel J Black
- Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Adelaide, Australia, Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Robin Christensen
- Musculoskeletal Statistics Unit at The Parker Institute, Bispebjerg, Denmark, Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Nilasha Ghosh
- Division of Rheumatology, Hospital for Special Surgery, New York, USA
| | | | - Joanna Robson
- Rheumatology Research, Centre for Health and Clinical Research, University of the West of England, Bristol, UK, Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Beverley Shea
- Bruyère Research Institute, Senior Methodologist, Ottawa Hospital Research Institute, Ottawa, Canada, Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jasvinder A Singhi
- Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL 35233 USA, Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 1720 Second Ave. South, Birmingham, AL 35294-0022, USA, Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd., Ryals Public Health Building, Room 220, Birmingham, AL, 35294-0022, USA
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Abbreviation
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, Marco A Alba Garibay, Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, IRB-CELLEX, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Marco A Alba Garibay
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, IRB-CELLEX, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Simon Decary
- Patient-Oriented Rehabilitation Lab (SPOR-REHAB), University of Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Canada
| | | | - Anthony P Fernandez
- Department of Dermatology & Department of Pathology Cleveland Clinic, Cleveland, OH, USA
| | - Helen I Keen
- School of Medicine, University of Western Australia, Perth, Australia, Rheumatology Department, Fiona Stanley Hospital, Perth, Australia
| | - Lauren King
- Department of Medicine, University of Toronto, Canada
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Inna Gaydukova
- North-Western State medical University named after II Mechnikov, Saint-Petersburg, Russia
| | - Michael D George
- University of Pennsylvania, Division of Rheumatology, Philadelphia, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow India
| | - Suellen Lyne
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Chetan Mukhtyar
- Rheumatologist, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Win Min Oo
- Rheumatology department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, USA
| | - Huai Leng Pisaniello
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, Australia, Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | | | - Oscar Russell
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Vitor Teixeira
- Serviço de Reumatologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Portugal
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | | | - Kevin Yip
- Division of Rheumatology, Hospital for Special Surgery, New York, USA
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan M Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, USA, Weill Cornell Medical College, New York, USA
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, Rheumatology Research Group, Basil Hetzel Institute, Adelaide, Australia, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
13
|
Grosskleg S, Beaton D, Conaghan P, Hofstetter C, Maxwell L, Shea B, Tugwell P, Bingham CO, Antonietta D'Agostino M, March L, Singh JA, Strand V, Wells G, Simon L. OMERACT 2020: A virtual (R)evolution. Semin Arthritis Rheum 2021; 51:588-592. [PMID: 33941384 DOI: 10.1016/j.semarthrit.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Dorcas Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Phil Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, UK
| | | | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bev Shea
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Clifton O Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, 5200 Eastern Avenue MFL Center 4300, Baltimore, MD 21224, USA
| | - Maria Antonietta D'Agostino
- Università Cattolica del Sacro Cuore, Rheumatology Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Department of Epidemiology at the UAB School of Public Health, Birmingham, AL, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - George Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
14
|
Nielsen SM, Boers M, de Wit M, Shea B, van der Windt DA, Reeves BC, Beaton D, Alten R, Toupin April K, Boonen A, Escorpizo R, Flurey C, Furst DE, Guillemin F, Leong A, Pohl C, Rasmussen MU, Singh JA, Smolen JS, Strand V, Verstappen SMM, Voshaar M, Woodworth TG, Ellingsen T, March L, Wells GA, Tugwell P, Christensen R. OMERACT consensus-based operational definition of contextual factors in rheumatology clinical trials: A mixed methods study. Semin Arthritis Rheum 2021; 51:601-606. [PMID: 33875246 DOI: 10.1016/j.semarthrit.2021.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To develop an operational definition of contextual factors (CF) [1]. METHODS Based on previously conducted interviews, we presented three CF types in a Delphi survey; Effect Modifying -, Outcome Influencing - and Measurement Affecting CFs. Subsequently, a virtual Special Interest Group (SIG) session was held for in depth discussion of Effect Modifying CFs. RESULTS Of 161 Delphi participants, 129 (80%) completed both rounds. After two rounds, we reached consensus (≥70% agreeing) for all but two statements. The 45 SIG participants were broadly supportive. CONCLUSION Through consensus we developed an operational definition of CFs, which was well received by OMERACT members.
Collapse
Affiliation(s)
- Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Maarten Boers
- Department of Epidemiology & Data Science, and Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Maarten de Wit
- OMERACT Patient Research Partner, Amsterdam, the Netherlands
| | - Beverly Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dorcas Beaton
- Institute for Work and Health, and Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rieke Alten
- Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik Charité, University Medicine Berlin, Germany
| | - Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, United States; Swiss Paraplegic Research, Nottwil, Switzerland
| | - Caroline Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; University of Washington, Seattle, California, United States; University of Florence, Florence, Italy
| | | | - Amye Leong
- Healthy Motivation, and Bone and Joint Decade, the Global Alliance for Musculoskeletal Health, Santa Barbara, CA, United States
| | - Christoph Pohl
- Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik Charité, University Medicine Berlin, Germany
| | - Marianne Uggen Rasmussen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, 700 19th St S, Birmingham 35233, AL United States; Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 1720 Second Ave. South, Birmingham, AL 35294-0022, United States; Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd., Ryals Public Health Building, Room 220, Birmingham, AL 35294-0022, United States
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, United States
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, The Netherlands. Department of Pharmacy, Radboudumc, Nijmegen, the Netherlands
| | - Thasia G Woodworth
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
15
|
Perez-Chada LM, Haberman RH, Chandran V, Rosen CF, Ritchlin C, Eder L, Mease P, Reddy S, Ogdie A, Merola JF, Scher JU. Consensus terminology for preclinical phases of psoriatic arthritis for use in research studies: results from a Delphi consensus study. Nat Rev Rheumatol 2021; 17:238-243. [PMID: 33589818 PMCID: PMC7997804 DOI: 10.1038/s41584-021-00578-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
The concept of psoriatic arthritis (PsA) prevention is gaining increased interest owing to the physical limitation, poor quality of life and low remission rates that are achieved with current therapies for PsA. The psoriasis-to-PsA transition offers a unique opportunity to identify individuals at increased risk of developing PsA and to implement preventive strategies. However, identifying individuals at increased risk of developing PsA is challenging as there is no consensus on how this population should be defined. This Consensus Statement puts forward recommended terminology from the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) for defining specific subgroups of individuals during the preclinical and early clinical phases of PsA to be used in research studies. Following a three-round Delphi process, consensus was reached for three terms and definitions: 'increased risk for PsA', 'psoriasis with asymptomatic synovio-entheseal imaging abnormalities' and 'psoriasis with musculoskeletal symptoms not explained by other diagnosis'. These terms and their definitions will enable improved identification and standardization of study populations in clinical research. In the future, as increasing evidence emerges regarding the molecular and clinical features of the psoriasis-to-PsA continuum, these terms and definitions will be further refined and updated.
Collapse
Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca H Haberman
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Christopher Ritchlin
- Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY, USA
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Philip Mease
- Seattle Rheumatology Associates, Swedish Medical Center and Providence St, Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Soumya Reddy
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Merola
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA.
| |
Collapse
|
16
|
Controversy and Debate Series on Core Outcome Sets. Paper 1: Improving the generalizability and credibility of core outcome sets (COS) by a large and international participation of diverse stakeholders. J Clin Epidemiol 2020; 125:206-212.e1. [DOI: 10.1016/j.jclinepi.2020.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/03/2019] [Accepted: 01/01/2020] [Indexed: 11/21/2022]
|
17
|
Veugelers R, Gaakeer MI, Patka P, Huijsman R. Improving design choices in Delphi studies in medicine: the case of an exemplary physician multi-round panel study with 100% response. BMC Med Res Methodol 2020; 20:156. [PMID: 32539717 PMCID: PMC7294633 DOI: 10.1186/s12874-020-01029-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background A proper application of the Delphi technique is essential for obtaining valid research results. Medical researchers regularly use Delphi studies, but reports often lack detailed information on methodology and controlled feedback: in the medical literature, papers focusing on Delphi methodology issues are rare. Since the introduction of electronic surveys, details on response times remain scarce. We aim to bridge a number of gaps by providing a real world example covering methodological choices and response times in detail. Methods The objective of our e(lectronic)-Delphi study was to determine minimum standards for emergency departments (EDs) in the Netherlands. We opted for a two-part design with explicit decision rules. Part 1 focused on gathering and defining items; Part 2 addressed the main research question using an online survey tool. A two-person consensus rule was applied throughout: even after consensus on specific items was reached, panellists could reopen the discussion as long as at least two panellists argued similarly. Per round, the number of reminders sent and individual response times were noted. We also recorded the methodological considerations and evaluations made by the research team prior to as well as during the study. Results The study was performed in eight rounds and an additional confirmation round. Response rates were 100% in all rounds, resulting in 100% consensus in Part 1 and 96% consensus in Part 2. Our decision rules proved to be stable and easily applicable. Items with negative advice required more rounds before consensus was reached. Response delays were mostly due to late starts, but once panellists started, they nearly always finished the questionnaire on the same day. Reminders often yielded rapid responses. Intra-individual differences in response time were large, but quick responders remained quick. Conclusions We advise those considering Delphi study to follow the CREDES guideline, consider a two-part design, invest in personal commitment of the panellists, set clear decision rules, use a consistent lay-out and send out your reminders early. Adopting this overall approach may assist researchers in future Delphi studies and may help to improve the quality of Delphi designs in terms of improved rigor and higher response rates.
Collapse
Affiliation(s)
- Rebekka Veugelers
- Emergency Department, Adrz hospital, P.O. Box 15 4460, AA, Goes, the Netherlands.
| | - Menno I Gaakeer
- Emergency Department, Adrz hospital, P.O. Box 15 4460, AA, Goes, the Netherlands
| | - Peter Patka
- Emergency Department, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| |
Collapse
|
18
|
March L, Richards B, Gill M, Brooks PM, Shea BJ, Beaton DE, Maxwell LJ, Tunis SR, Grosskleg S, Tugwell P. Introduction. J Rheumatol 2019; 46:962-968. [PMID: 31371663 DOI: 10.3899/jrheum.190105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lyn March
- Sydney Medical School, Institute of Bone and Joint Research, and Department of Rheumatology, Royal North Shore Hospital, St. Leonards, Australia
| | - Bethan Richards
- Department of Rheumatology, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Gill
- OMERACT Patient Research Partner, Dragon Claw, Canberra, Australia
| | - Peter M Brooks
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Beverley J Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Dorcas E Beaton
- Institute for Work and Health, and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lara J Maxwell
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
| | - Sean R Tunis
- Center for Medical Technology Policy (CMTP), World Trade Center Baltimore, Baltimore, Maryland, USA
| | - Shawna Grosskleg
- Secretariat, OMERACT, University of Ottawa, Ottawa, Ontario, Canada;
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Maxwell LJ, Beaton DE, Shea BJ, Wells GA, Boers M, Grosskleg S, Bingham CO, Conaghan PG, D’Agostino MA, de Wit M, Gossec L, March L, Simon LS, Singh JA, Strand V, Tugwell P. Core Domain Set Selection According to OMERACT Filter 2.1: The OMERACT Methodology. J Rheumatol 2019; 46:1014-1020. [DOI: 10.3899/jrheum.181097] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/23/2022]
Abstract
Objective.To describe the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 methodology for core domain set selection.Methods.The “OMERACT Way for Core Domain Set selection” framework consists of 3 stages: first, generating candidate domains through literature reviews and qualitative work, then a process of consensus to obtain agreement from those involved, and finally formal voting on the OMERACT Onion. The OMERACT Onion describes the placement of domains in layers/circles: mandatory in all trials/mandatory in specific circumstances (inner circle); important but optional (middle circle); or research agenda (outer circle). Five OMERACT working groups presented their core domain sets for endorsement by the OMERACT community. Tools including a workbook and whiteboard video were created to assist the process. The methods workshop at OMERACT 2018 introduced participants to this framework.Results.The 5 OMERACT working groups achieved consensus on their proposed core domain sets. After the Methodology Workshop training exercise at OMERACT 2018, over 90% of participants voted that they were confident that they understood the process of core domain set selection.Conclusion.The methods described in this paper were successfully used by the 5 working groups voting on domains at the OMERACT 2018 meeting, demonstrating the feasibility of the process. In addition, participants at OMERACT 2018 expressed increased confidence and understanding of the core domain set selection process after the training exercise. This methodology will continue to evolve, and we will use innovative technology such as whiteboard videos as a key part of our dissemination and implementation strategy for new methods.
Collapse
|