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Côté CI. A critical and systematic literature review of epistemic justice applied to healthcare: recommendations for a patient partnership approach. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:455-477. [PMID: 38833134 DOI: 10.1007/s11019-024-10210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
Invalidation from healthcare practitioners is an experience shared by many patients, especially those marginalized or living with contested conditions (e.g., chronic pain, fibromyalgia, etc.). Invalidation can include not taking someone's testimony seriously, imposing one's thoughts, discrediting someone's emotions, or not perceiving someone's testimony as equal and competent. Epistemic injustices, that is, the disqualification of a person as a knower, are a form of invalidation. Epistemic injustices have been used as a theoretical framework to understand invalidation that occurs in the patient-healthcare provider relationship. However, to date, the different recommendations to achieve epistemic justice have not been listed, analyzed, nor compared yet. This paper aims at better understanding the state of the literature and to critically review possible avenues to achieve epistemic justice in healthcare. A systematic and critical review of the existing literature on epistemic justice was conducted. The search in four databases identified 629 articles, from which 35 were included in the review. Strategies to promote epistemic justice that can be applied to healthcare are mapped in the literature and sorted in six different approaches to epistemic justice, including virtuous, structural, narrative, cognitive, and partnership approaches, as well as resistance strategies. These strategies are critically appraised. A patient partnership approach based on the Montreal Model, implemented at all levels of healthcare systems, seems promising to promote epistemic justice in healthcare.
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Affiliation(s)
- Catherine Isadora Côté
- Department of Political Science, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada.
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Baudrier C, Petitcuenot V, Oussedik N, Champeau W, Alarab R, Lefebvre AL, Rahma Y, Bottois C, Conort O. [Evaluation of medication self-administration feasibility in a university hospital: Clinical audits and recommendations]. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00111-1. [PMID: 39154956 DOI: 10.1016/j.pharma.2024.08.004] [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: 06/05/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
The French Health Authority recently published guidelines about patient self-administration of medications for voluntary hospitalized patients under medical supervision. This study aimed to assess medication management practices in our hospital and provide recommendations for self-administration medication. A prospective monocentric study was performed from January to June 2023, involving patient and nurse surveys based on the guidelines from the French Health Authority. A total of 207 patients participated in the survey, with a mean age of 59.6years. Among them, 56% were inclined to self-manage treatments initiated during hospitalization. Among patients with regular treatments, 62% were inclined to self-manage them in the hospital. In weekday hospitalization units, 92% of patients were inclined to self-manage their regular treatments, and 75% of those initiated during hospitalization. Among the 26 surveyed nurses, 71% reported patient autonomy for taking drugs in narrative transmissions, and 88% verified medication intake through self-administration, while 96% digitally traced it. The concept of self-administration of medication appears promising, especially within weekday hospitalization units, particularly for patients with a good understanding of their treatment. Nurses currently assess patient autonomy without specific monitoring tools. Collaborative efforts among healthcare professionals, with pharmacists playing a central role, are essential for the success of this innovative approach.
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Affiliation(s)
- Cyril Baudrier
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France.
| | - Victoire Petitcuenot
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Nacima Oussedik
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - William Champeau
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Rouba Alarab
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Anne-Laure Lefebvre
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Yara Rahma
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Cecile Bottois
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
| | - Ornella Conort
- Pharmacie, hôpitaux universitaires Paris Centre-Site Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Pharmacy Department, Cochin Hospital (Assistance publique-Hôpitaux de Paris), Paris, France
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Madar J, Gaucher M, Barbaroux A, Delotte J, Boudy CA. [Risks of urogenital infections and expulsion associated with the combination of an IUD and a menstrual cup]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00259-9. [PMID: 39004187 DOI: 10.1016/j.gofs.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES The increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products. METHOD An observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users. RESULTS One hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2=3.65; P=0.056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34.6%) of the non-users or not regular users, with no statistically significant difference. CONCLUSION The tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.
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Affiliation(s)
- Johanna Madar
- Université Côte d'Azur (UCA), Rétines, Healthy, département d'Enseignement et de Recherche en Médecine Générale (DERMG), 28, avenue de Valombrose, 06107 Nice cedex 2, France.
| | - Méghane Gaucher
- Université Côte d'Azur (UCA), Rétines, Healthy, département d'Enseignement et de Recherche en Médecine Générale (DERMG), 28, avenue de Valombrose, 06107 Nice cedex 2, France
| | - Adriaan Barbaroux
- Université Côte d'Azur (UCA), Rétines, LAPCOS, Healthy, département d'Enseignement et de Recherche en Médecine Générale (DERMG), 28, avenue de Valombrose, 06107 Nice cedex 2, France
| | - Jérôme Delotte
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital de l'Archet 2, 151, route de Ginestière, 06202 Nice cedex 3, France
| | - Carol-Anne Boudy
- Université Côte d'Azur (UCA), Rétines, Healthy, département d'Enseignement et de Recherche en Médecine Générale (DERMG), 28, avenue de Valombrose, 06107 Nice cedex 2, France
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Maison P, Bacon T, Daynes P, Decoene C, Mazet R, Vial T, Vignot S, Belgodère L, Oualikene-Gonin W, Ratignier-Carbonneil C. [Balancing drug regulation and health democracy: The role of patient and healthcare professional advisors at the ANSM]. Therapie 2024:S0040-5957(24)00070-2. [PMID: 38971714 DOI: 10.1016/j.therap.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
The French National Agency for Health Products (ANSM) is a regulatory and public health agency. Its regulatory, health policing and public health protection activities require a perfect fit with the field and the various people involved in the use of health products. Since 2019, the ANSM has adapted its organisation, procedures and processes to encourage and improve interaction with its stakeholders, as part of its policy of openness towards civil society. To accompany this ambitious change and to support its staff, the Agency has recruited advisors corresponding to the main users of health products: prescribers (doctor's hospital and outpatient), pharmacists and patients. Working as a group or individually, they provide a "lived" user perspective on health products at each stage of the evaluation process. They may be involved in the assessment of dossiers, signals or applications received by the Agency, in the internal validation of reports or in discussions with stakeholders. They are particularly involved when the analysis requires expertise that goes beyond the technical, scientific or regulatory aspects. They may also work with ANSM staff to explain certain processes and difficulties in the field. Advisors help to ensure that regulatory and/or scientific expertise is clear and consistent with user experience. In addition to their scientific and therapeutic aspects, medicines are also economic, social and political issues. Their regulation is therefore particularly affected by the need for health democracy. This requires the active participation of health professionals, patients and, more broadly, civil society in the decision-making process. Civil society is a space occupied by a wide range of actors who exert pressure from different ideological positions to influence the regulation of health products. In this context, taking into account a plurality of viewpoints in the regulation of health products is necessary and complex, but its operation can be facilitated by the collective efforts of the actors and the adaptation of organisations, such as the integration of advisors.
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Affiliation(s)
- Patrick Maison
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; EA 7379, faculté de santé, université Paris-Est Créteil, CHI de Créteil, 94000 Créteil, France.
| | - Trystan Bacon
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; Collège universitaire de médecine générale, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Pascale Daynes
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; Union francophone des patients partenaires, faculté de médecine, centre hospitalier universitaire Grenoble-Alpes, 38700 La Tronche, France
| | - Christophe Decoene
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; Pôle anesthésie-réanimation, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - Roseline Mazet
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; Centre hospitalier universitaire de Grenoble-Alpes, 38000 Grenoble, France
| | - Thierry Vial
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; Service hospitalo-universitaire de pharmacotoxicologie, hospices civils de Lyon, 69000 Lyon, France
| | - Stéphane Vignot
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France; EA7509 IRMAIC, université de Reims Champagne-Ardenne, 51100 Reims, France; Département d'oncologie médicale, institut Godinot, 51100 Reims, France
| | - Laetitia Belgodère
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
| | - Wahiba Oualikene-Gonin
- Agence nationale de sécurité du médicament et des produits de santé (ANSM), 93285 Saint-Denis, France
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Bruneau C, Genolini JP, Terral P. Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients' knowledge and power to act. PLoS One 2024; 19:e0304899. [PMID: 38843167 PMCID: PMC11156290 DOI: 10.1371/journal.pone.0304899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain.
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Affiliation(s)
- Charlotte Bruneau
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
| | - Jean-Paul Genolini
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
| | - Philippe Terral
- Center for Research in Social Sciences, Sports and Body, University Paul Sabatier Toulouse, Toulouse, France
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Kabbes N, Bugra A, Wissanji H, Osmanlliu E. Telehealth for Indigenous Children Worldwide: A Scoping Review. J Pediatr Surg 2024; 59:908-917. [PMID: 38413263 DOI: 10.1016/j.jpedsurg.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Indigenous children worldwide face healthcare disparities due, in part, to resource scarcity in remote settings which may be mitigated with technology. This study aims to determine the use of telehealth for this population, with respect to feasibility, acceptability, and the degree of patient/family involvement in reported interventions. We focused on the use of telehealth to support perioperative care. METHODS To identify relevant studies, five databases were searched to find articles that focused on the role of telehealth in caring for Indigenous populations worldwide, with an emphasis on the pediatric population. Studies that lacked insight into those themes, as well as protocols and review articles, were excluded. Analysis was done according to the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, the Montreal Model (patient involvement), and the theoretical framework of acceptability (TFA). RESULTS Of the 1690 articles screened, 34 met the eligibility criteria. The most frequent uses of telehealth for Indigenous children were in ENT and psychiatry. Most of those had a low degree of complexity across the NASSS framework domains, suggesting greater feasibility. In 13 articles, the patient involvement was limited to information (lowest level of involvement in the Montreal Model). Only 11 articles directly assessed patient/family-perceived acceptability. Finally, two articles addressed telehealth in the surgical context. CONCLUSIONS The relative simplicity of the proposed telehealth applications may support their sustained impact and use in other settings such as for perioperative care. Early and longitudinal involvement of communities is essential for responsible telehealth development that addresses local needs. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nour Kabbes
- McGill Faculty of Medicine, Montreal, QC, Canada
| | - Adalet Bugra
- McGill Faculty of Medicine, Montreal, QC, Canada
| | - Hussein Wissanji
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Esli Osmanlliu
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Pomey MP, Jutras-Aswad D, Paquette J, Saadi K, Taguemout M, Ikene DL, Arbour N, Zertal A, Fréjeau N, Morin D, Ouellette JS, Alami Marrouni K, Duquette P. Perceptions and engagement of patients with chronic conditions on the use of medical cannabis: a scoping review. Eur J Med Res 2024; 29:211. [PMID: 38561859 PMCID: PMC10983766 DOI: 10.1186/s40001-024-01803-w] [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: 03/12/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
CONTEXT Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC. OBJECTIVES This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research. METHODS We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals. RESULTS Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients. CONCLUSIONS Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated.
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Affiliation(s)
- Marie-Pascale Pomey
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada.
- School of Public Health, Department of Health Management, Evaluation of Policy, Université de Montréal, 7101 Du Parc Avenue 3rd Floor, Montréal, QC, H3N 1X9, Canada.
- Centre of Excellence on Partnership with Patients and the Public, Montréal, QC, Canada.
| | - Didier Jutras-Aswad
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | - Jesseca Paquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Kamilla Saadi
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Anthropology, Université de Montréal, Montréal, QC, Canada
| | - Mélissa Taguemout
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Dina-Liza Ikene
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Arbour
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Amel Zertal
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Fréjeau
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Danielle Morin
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Jean-Sylvain Ouellette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Multiple Sclerosis Society of Canada, Toronto, ON, Canada
| | - Kanza Alami Marrouni
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Duquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Chapron P, Petit M, Huon JF, Nizet P. [Implementation of pharmaceutical consultations in digestive oncology in a teaching hospital: one-year outcomes]. Bull Cancer 2024; 111:363-370. [PMID: 38438283 DOI: 10.1016/j.bulcan.2024.01.003] [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: 11/10/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The announcement of a cancer diagnosis is traumatic for the patient. In France, an announcement system has been in place, providing medical time for announcement and treatment proposal, nursing time for support, without including the pharmacist. In order to improve management of patients treated with intravenous anticancer drugs, we set up introductory pharmaceutical consultations in digestive oncology. The aims were to assess the situation one year after the introduction of these consultations, and to assess their contribution. METHODS When a patient was diagnosed with digestive cancer and receiving intravenous treatment, a pharmaceutical initiation consultation was scheduled. Indicators of activity (number of consultations, average duration, average preparation time and various delays) and results (number and type of pharmaceutical interventions, patient satisfaction) were collected in order to assess activity. RESULTS Forty-seven pharmaceutical initiation consultations were carried out. The average duration of the consultations was 39.3minutes. Consultations were carried out on average 12.1 days after the medical consultation and 9.6 days before the first chemotherapy treatment. Twenty-nine patients responded to the satisfaction questionnaire. All were satisfied, and the majority of patients said they had improved their knowledge of cancer treatment. DISCUSSION This activity enables us to review with patients essential aspects of their care, such as implanting an implantable chamber catheter, anti-cancer treatment and managing potential side effects and improve their self-care skills.
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Affiliation(s)
- Pierre Chapron
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Mathilde Petit
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Jean-François Huon
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Pierre Nizet
- Pharmacie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Massé J, Grignon S, Vigneault L, Olivier-D'Avignon G, Tremblay MC. Patients' perspectives on their motivations for participating in non-clinical medical teaching and what they gain from their experience: a qualitative study informed by critical theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:217-243. [PMID: 37382856 DOI: 10.1007/s10459-023-10262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
In 2019-2021, we engaged in a project aimed at developing, implementing, and evaluating an educational intervention actively involving patient-teachers in undergraduate medical education at Université Laval, Quebec, Canada. Patient-teachers were invited to participate in small group discussion workshops during which medical students deliberate on legal, ethical, and moral issues arising from medical practice. Patients were expected to bring other perspectives, based on their experience with illness and the healthcare system. Little is still known about patients' perspectives on their participation experience in such context. Informed by critical theory, our qualitative study aims to document,: (i) the motivating factors for patients' participation in our intervention; and (ii) what patients gained from the experience. Data collection was based on 10 semi-structured interviews with patient-teachers. A thematic analysis was conducted using NVivo software. Motivators for participation arose from: (i) perceived consistency between patients' individual characteristics and those of the project, and (ii) conceiving the project as a means to reach individual and social goals. What patients gained mainly refers to (1) the appreciation of a positive, enriching, motivating yet uncomfortable and destabilizing experience; (2) a deconstruction of biases against the medical field and critical thinking about their own experience; (3) new knowledge, with a potential impact on their future interactions with the healthcare system. Results reveal patients as non-neutral thinking and knowing subjects, engaged in the participation experience as active teachers and learners. They also highlight the empowering and emancipatory nature of the learning gained through patients' participation experience. These conclusions prompt us to promote transformative interventional approaches that question the pervasive power issues in medical teaching and value patients' specific knowledge in teaching and learning the Art of Medicine.
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Affiliation(s)
- Julie Massé
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada.
- Faculty of nursing, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada.
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada.
| | - Sophie Grignon
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Patient-Partner, Quebec City, Québec, Canada
| | - Luc Vigneault
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada
- Patient-Partner, Quebec City, Québec, Canada
| | | | - Marie-Claude Tremblay
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada
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10
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Ma Y, Achiche S, Pomey MP, Paquette J, Adjtoutah N, Vicente S, Engler K, Laymouna M, Lessard D, Lemire B, Asselah J, Therrien R, Osmanlliu E, Zawati MH, Joly Y, Lebouché B. Adapting and Evaluating an AI-Based Chatbot Through Patient and Stakeholder Engagement to Provide Information for Different Health Conditions: Master Protocol for an Adaptive Platform Trial (the MARVIN Chatbots Study). JMIR Res Protoc 2024; 13:e54668. [PMID: 38349734 PMCID: PMC10900097 DOI: 10.2196/54668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. OBJECTIVE In response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. METHODS The MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. RESULTS From July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l'Université de Montréal (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). CONCLUSIONS This master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. TRIAL REGISTRATION ClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54668.
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Affiliation(s)
- Yuanchao Ma
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sofiane Achiche
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Nesrine Adjtoutah
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Moustafa Laymouna
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Benoît Lemire
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Rachel Therrien
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Esli Osmanlliu
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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11
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Montiel C, Bedrossian N, Myre A, Kramer A, Piché A, Mcdonough MH, Sabiston CM, Petrella A, Gauvin L, Doré I. "In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope. Am J Mens Health 2024; 18:15579883231215153. [PMID: 38179864 PMCID: PMC10771074 DOI: 10.1177/15579883231215153] [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: 09/12/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024] Open
Abstract
Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.
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Affiliation(s)
| | - Nathalie Bedrossian
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - André Myre
- Peer Researcher, Montréal, Quebec, Canada
| | | | - Alexia Piché
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Anika Petrella
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Lise Gauvin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Isabelle Doré
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
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12
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Wiesner Conti J, Paignon A, Kalumiya K. Optimiser le co-enseignement patient/professionnel de santé. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2024; 36:35-44. [PMID: 38834523 DOI: 10.3917/spub.242.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Patient engagement in the training of future health professionals is on the rise, given that the information patients transmit is immensely valuable to students. In addition, their involvement, alongside health professionals, in the formulation of academic materials should improve the quality of care in the long run. Little is written about good practice in involving patients in teaching, and even less about co-teaching, which is a demanding activity. We conducted a study with pairs of teachers who co-taught in health partnership workshops to develop best practice recommendations to optimize the roll-out of patient-healthcare professional co-teaching. PURPOSE OF THE RESEARCH This qualitative study aims to present these recommendations of good practices of co-teaching. RESULTS The data collected made it possible to develop, evaluate, and adjust six good practices to guide the pairs during the co-teaching process: knowledge of the subject taught, regular meetings, teaching framework and materials, role definition, symmetry and complementarity in the pair, and a debriefing session following each teaching session. CONCLUSION Patient involvement in co-teaching requires rigorous preparation. The application of good practice recommendations facilitates this preparation process.
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13
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Morin A, Couturier Y, Poirier MD, T Vaillancourt V, Massé S, D Tardif A, Poitras ME. The impact of patients as trainers on registered nurses' patient engagement in primary care clinics: a qualitative study. BMC PRIMARY CARE 2023; 24:265. [PMID: 38087266 PMCID: PMC10717897 DOI: 10.1186/s12875-023-02210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND In Canada, primary care is usually the front door to health care for people with health issues. Among these primary care services are primary care clinics (PCC), where the competencies of registered nurses (RNs) are needed. However, nursing practice in PCCs is variable and sometimes suboptimal from one PCC to another. In 2019, the Quebec Ministry of Health and Social Services deployed a practical guide for RNs practicing in PCCs. This guide was intended to support best professional and interprofessional practices and enhance the quality of services offered according to a physical-social vision of care, interprofessional collaboration and partnership with the patient. The Formation de formateurs en première ligne (F2PL) project team developed a train-the-trainer educational intervention to support RNs in assimilating the content of this guide. This educational intervention is uncommon because it includes patients as trainers (PTs). PTs developed and provided andragogic content about patient's experience to enhance patient engagement. OBJECTIVE To describe the impacts of the educational intervention provided by the PTs in nurses' patient engagement practices in PCCs. METHODS A descriptive qualitative approach was used to describe in-depth changes in RNs' practices. Individual interviews were conducted with 10 RNs and 3 PTs to explore the changes in RNs' practice and the barriers and facilitators to adopting this new practice. An inductive and deductive thematic analysis was carried out according to a conceptual model of patient engagement (the Montreal Model), and emerging themes were condensed into propositions. To ensure credibility, a peer review was conducted with the F2PL team, which includes a patient co-leader. RESULTS The educational intervention provided by PTs has impacted RNs' practice in 3 ways: awareness or reminding of general principles, updating commitment to already known principles and enhancing the development of new professional skills. CONCLUSIONS PTs could effectively support the RNs' motivation to use patient engagement practices in primary care.
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Affiliation(s)
- A Morin
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - Y Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - M-D Poirier
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - V T Vaillancourt
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - S Massé
- School of Nursing, Université du Québec À Chicoutimi, Chicoutimi, Canada
| | - A D Tardif
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - M-E Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada.
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada.
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada.
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Legobien A, Martin H, Bontemps V, Maroni JP, Thomas C, Canale C, Ursulet JP, Abraham G, Marchand C, Crozet C. A municipal health center’s co-constructed therapeutic patient education program for patients with single or multiple morbidities. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 35:405-416. [PMID: 38078635 DOI: 10.3917/spub.234.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Introduction The accessibility of Therapeutic Patient Education (TPE) is essential to reduce social inequalities and to meet the challenges posed by the increase in chronic diseases. In France, the distribution of TPE throughout the territory is heterogeneous and patients still lack sufficient access. With these perspectives in mind, a municipal health center has developed an innovative TPE device by involving concerned patients from the outset. Objectives The objectives of this article are to present the methodology implemented to co-construct a TPE program for patients with one or more prevalent diseases in the territory, as well as the results of the co-construction. Methods Creation of a project team with various actors: patients, health professionals, administrators, researchers. Organization of synchronous and asynchronous times. Results Four meetings and numerous exchanges made it possible to: define the common values and operating rules of the project team, reflect on the coordination of the care pathway, identify the specific and shared needs of patients affected by type 2 diabetes, arterial hypertension and/or obesity, agree on the principles of the device. Conclusion The advantages of this device were discussed: flexible organization with numerous links with local actors, development of partnerships, expansion of the population concerned. Questions and difficulties were encountered, such as the coordination of actors and the representation of partner patients for the targeted diseases. This device will be tested and evaluated, mainly with an objective of improving it.
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Affiliation(s)
- Anthony Legobien
- Centres Municipaux de Santé Pluridisciplinaires – Le Blanc-Mesnil – France
| | - Hubert Martin
- Centres Municipaux de Santé Pluridisciplinaires – Le Blanc-Mesnil – France
| | - Véronique Bontemps
- Centres Municipaux de Santé Pluridisciplinaires – Le Blanc-Mesnil – France
| | - Jean-Pierre Maroni
- Centres Municipaux de Santé Pluridisciplinaires – Le Blanc-Mesnil – France
| | | | | | | | | | - Claire Marchand
- Laboratoire Éducations et Promotion de la Santé (LEPS UR 3412), Université Sorbonne Paris Nord – Bobigny – France
| | - Cyril Crozet
- Laboratoire Éducations et Promotion de la Santé (LEPS UR 3412), Université Sorbonne Paris Nord – Bobigny – France
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15
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Wilson TN, Roquelaure Y, Evanoff B, Aublet-Cuvelier A, Porro B. Physical activity in people diagnosed with cancer: a rapid review of recommendations and critical appraisal of international guidelines. Support Care Cancer 2023; 31:679. [PMID: 37934319 DOI: 10.1007/s00520-023-08123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE There are numerous guidelines that recommend physical activity (PA) in people diagnosed with cancer, but the quality of these guidelines is unknown. The aim of this study was to identify existing PA guidelines for cancer survivors, describe the recommendations, and assess their methodology quality. METHODS A rapid review of the literature was conducted in PubMed and EMBASE, supplemented by a search of the grey literature. The methodological quality of the guidelines was assessed using the AGREE II checklist. A descriptive synthesis of the recommendations from guidelines judged to be of good quality has been performed. RESULTS A total of nine guidelines published between 2006 and 2019 were included. Of nine guidelines, five achieved a high enough AGREE II score and were judged to be of good quality for use in clinical practice. We found that the recommendations from the five guidelines converged on the prescription of supervised PA (aerobic and resistance exercise) of at least 75 min per week of high intensity or 150 min per week of moderate intensity, spread over two to five sessions per week, equating to a PA dose between 8.70 and 17.5 MET.h/week. The recommendations were applicable to address the most common side effects of cancer and its treatment, namely fatigue, lymphedema, anxiety, depressive symptoms, health-related quality of life (QoL), survival, and physical function. However, no guideline recommends PA to improve other cancer-related outcomes, such as cognitive impairment, falls, sexual function, and peripheral neuropathy frequently experienced by cancer survivors. No guideline also referred to work outcomes (i.e., work ability, return to work, etc.). CONCLUSION Most PA guidelines for cancer survivors are of good quality. However, specific PA guidelines are needed for a given cancer site (e.g., location, stage), at a particular phase of the cancer trajectory, and for specific outcomes including return to work (RTW) in order to tailor PA to each cancer survivor.
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Affiliation(s)
- Têtê Norbert Wilson
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France.
- Grain de Sel Togo, Inc., Athens, USA.
| | - Yves Roquelaure
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
| | - Bradley Evanoff
- Washington University in St. Louis, School of Medicine, St. Louis, USA
| | - Agnès Aublet-Cuvelier
- INRS (Institut National de Recherche et de Sécurité), Direction des Etudes et de la Recherche, 1 rue du Morvan, CS60027, 54519, Vandœuvre-lès-Nancy, France
| | - Bertrand Porro
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
- Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest (ICO), 49055, Angers, France
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16
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Massé J, Beaura S, Tremblay MC. Fostering the development of non-technical competencies in medical learners through patient engagement: a rapid review. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:47-69. [PMID: 37719397 PMCID: PMC10500390 DOI: 10.36834/cmej.73630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background To train physicians who will respond to patients' evolving needs and expectations, medical schools must seek educational strategies to foster the development of non-technical competencies in students. This article aims to synthetize studies that focus on patient engagement in medical training as a promising strategy to foster the development of those competencies. Methods We conducted a rapid review of the literature to synthetize primary quantitative, qualitative and mixed studies (January 2000-January 2022) describing patient engagement interventions in medical education and reporting non-technical learning outcomes. Studies were extracted from Medline and ERIC. Two independent reviewers were involved in study selection and data extraction. A narrative synthesis of results was performed. Results Of the 3875 identified, 24 met the inclusion criteria and were retained. We found evidence of a range of non-technical educational outcomes (e. g. attitudinal changes, new knowledge and understanding). Studies also described various approaches regarding patient recruitment, preparation, and support and participation design (e.g., contact duration, learning environment, patient autonomy, and format). Some emerging practical suggestions are proposed. Conclusion Our results suggest that patient engagement in medical education can be a valuable means to foster a range of non-technical competencies, as well as formative and critical reflexivity. They also suggest conditions under which patient engagement practices can be more efficient in fostering non-instrumental patient roles in different educational contexts. This supports a plea for sensible and responsive interventional approaches.
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Affiliation(s)
- Julie Massé
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
- VITAM, Centre de recherche en santé durable, Quebec, Canada
- Faculty of nursing, Université Laval, Quebec, Canada
| | - Stéphanie Beaura
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
- VITAM, Centre de recherche en santé durable, Quebec, Canada
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Belgodère L, Pougheon Bertrand D, Jaulent MC, Rabeharisoa V, Janssens W, Rollason V, Barbot J, Vernant JP, Oualikene Gonin W, Maison P, Ankri J. Patient and public involvement in the benefit-risk assessment and decision concerning health products: position of the Scientific Advisory Board of the French National Agency for Medicines and Health Products Safety (ANSM). BMJ Glob Health 2023; 8:bmjgh-2023-011966. [PMID: 37208125 DOI: 10.1136/bmjgh-2023-011966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
| | - Dominique Pougheon Bertrand
- Laboratoire Educations et Promotion de la santé, LEPS, UR 3412, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Marie Christine Jaulent
- INSERM, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, LIMICS, Sorbonne Université, Paris, France
| | - Vololona Rabeharisoa
- Centre de sociologie de l'innovation, UMR CNRS i3 (9217), Mines Paris - PSL, Paris, France
| | - Walter Janssens
- Federal Agency for Medicines and Health Products, Brussel, Belgium
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Janine Barbot
- Centre d'étude des mouvements sociaux (CNRS-EHESS 8044, INSERM 1276), INSERM, Paris, France
| | - Jean Paul Vernant
- Service Hématologie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | | | - Patrick Maison
- Délégation scientifique, ANSM, Saint-Denis, France
- EA 7379, Faculté de Santé, Université Paris-Est Créteil Val de Marne, Creteil, France
| | - Joel Ankri
- Inserm U1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Universite Versailles Saint-Quentin-en-Yvelines UFR de Medecine, Montigny-Le-Bretonneux, France
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18
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Belhomme N, Lescoat A, Launey Y, Jégo P, Cavalin C, Pottier P. [Tolerating uncertainty: Towards a competence-based approach]. Rev Med Interne 2023; 44:27-30. [PMID: 36371326 DOI: 10.1016/j.revmed.2022.10.387] [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: 09/12/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.
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Affiliation(s)
- N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Y Launey
- Réanimation chirurgicale, département d'anesthésie-réanimation-médecine Périopératoire, CHU de Rennes, université Rennes 1, Rennes, France
| | - P Jégo
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - C Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Université Paris-Dauphine, PSL, Paris, France; Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Sciences Po, Paris, France; Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - P Pottier
- Service de médecine interne et immunologie clinique, CHU Nantes, Nantes, France; Faculté de médecine-pôle santé, Nantes Université, Nantes, France
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Shankland M, Ferrand A, Ganache I, Côté MA, Pomey MP. Ethical Foundations of the Accompanying Patient's Role for an Enhanced Patient Experience: A Scoping Review. J Pers Med 2022; 13:77. [PMID: 36675737 PMCID: PMC9863322 DOI: 10.3390/jpm13010077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
In recent years, recognizing patients' experiential knowledge to improve the quality of care has resulted in the participation of patient advisors at various levels of healthcare systems. Some who are working at the clinical level are called accompanying patients (AP). A PRISMA-ScR exploratory scoping review of the literature was conducted on articles published from 2005 to 2021. Articles not in English or French and grey literature were excluded. The databases searched included Medline, PubMed, Scopus, and Google Scholar. The data were organized according to the similarities in the ethical foundations of the included papers. Out of 2095 identified papers, 8 met inclusion criteria. Terms used to describe APs included peer support, resource parent, and peer health mediator. The clinical settings included psychiatry/mental health and neonatology. APs, patients, healthcare professionals, managers and policy makers were included in the studies. Three personal ethical foundations describing the foundations of the AP role were found: resilience, listening skills and altruism. The ethical foundations of this role also addressed interpersonal and interprofessional relationships with other actors in the healthcare system. The literature on the ethical foundations of APs is sparse, with heterogeneous methodologies. Further studies mobilizing well-defined methodologies would further validate the current results and deepen our understanding of the ethical foundations of the AP role.
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Affiliation(s)
- Mylène Shankland
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
| | - Amaryllis Ferrand
- Pragmatic Health Ethics Research Unit, Montreal Clinical Research Institute (IRCM), Université de Montréal, Montréal, QC H2W 1R7, Canada
| | - Isabelle Ganache
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
| | | | - Marie-Pascale Pomey
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
- CHUM Research Centre, Health Innovation and Evaluation Hub, Montréal, QC H2X 0A9, Canada
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Savard Lamothe A, Gabet M, Richard Z, Oliveira SRDA, Coulibaly A, Cazarin G, Zacarias A, Gautier L, Ridde V, Zinszer K. A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife. Int J Public Health 2022; 67:1604992. [PMID: 36213140 PMCID: PMC9537363 DOI: 10.3389/ijph.2022.1604992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil. Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities. Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources. Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.
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Affiliation(s)
- Ashley Savard Lamothe
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Morgane Gabet
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Zoé Richard
- Institut de Recherche pour le Développement (IRD) Université de Paris, Paris, France
- Centre Population et Développement (Ceped), Paris, France
| | | | | | - Gisèle Cazarin
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Amanda Zacarias
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Lara Gautier
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
| | - Valéry Ridde
- Institut de Recherche pour le Développement (IRD) Université de Paris, Paris, France
- Centre Population et Développement (Ceped), Paris, France
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
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21
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Burnier I, Northrop G, Fotsing S. Nomenclature of real patients in health professional education by role and engagement: a narrative literature review. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:69-76. [PMID: 36310908 PMCID: PMC9588179 DOI: 10.36834/cmej.72429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Research problem Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy. Objective Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement. Methods The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals. Results Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically. Conclusion Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.
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Affiliation(s)
- Isabelle Burnier
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Grace Northrop
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Salomon Fotsing
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
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22
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Hallé MC, Delorme C, Coulombe É, Rekik O, Verduyckt I. Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:951426. [PMID: 36189073 PMCID: PMC9397883 DOI: 10.3389/fresc.2022.951426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022]
Abstract
The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named “Musculation de la Voix” (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: “Previous SLT services are variable and perceived as beneficial but with limitations,” and three themes pertaining to MdlV: “Seeking improvement and support as initial motivations to engage in MdlV,” “Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV,” and “Perceived limitations of MdlV and persisting needs.” Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.
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Affiliation(s)
- Marie-Christine Hallé
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Charline Delorme
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Édith Coulombe
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Ouswa Rekik
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Ingrid Verduyckt
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
- *Correspondence: Ingrid Verduyckt
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Osmanlliu E, Paquette J, Grenier AD, Lewis P, Bouthillier ME, Bédard S, Pomey MP. Fantastic perspectives and where to find them: involving patients and citizens in digital health research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:37. [PMID: 35918730 PMCID: PMC9343826 DOI: 10.1186/s40900-022-00374-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Digital contact tracing and exposure notification apps have quickly emerged as a potential solution to achieve timely and effective contact tracing for the SARS-CoV-2 virus. Nonetheless, their actual uptake remains limited. Citizens, including patients, are rarely consulted and included in the design and implementation process. Their contribution supports the acceptability of such apps, by providing upstream evidence on incentives and potential barriers that are most relevant to users. The DIGICIT (DIGITal CITizenship) project relied on patient and citizen partnership in research to better integrate public perspectives on these apps. In this paper, we present the co-construction process that led to the survey instrument used in the DIGICIT project and the interpretation of its results. This approach promotes public participation in research on contact tracing and exposure notification apps, as well as related digital health applications. OBJECTIVES This article has three objectives: (1) describe the methodological process to co-construct a questionnaire and interpret the survey results with patients and citizens, (2) assess their experiences regarding this methodology, and (3) propose best practices for their involvement in digital health research. METHODS The DIGICIT project was developed in four steps: (1) creation of the advisory committee composed of patients and citizens, (2) co-construction of a questionnaire, (3) interpretation of survey results, and (4) assessment of the experience of committee participants. RESULTS Of the 25 applications received for participation in the advisory committee, we selected 12 people based on pre-established diversity criteria. Participants initially generated 84 survey questions in the first co-construction meeting, and eventually selected 36 in the final version. Participants made more than 20 recommendations when interpreting survey results and suggested carrying out focus groups with marginalized populations to increase representativity. They appreciated their inclusion early in the research process, being listened to and respected, the collective intelligence, and the method used for integrating their suggestions. They suggested that the study objectives and roles be better defined, that more time in the brainstorming sessions be allowed, and that discussion outside of meetings be encouraged. CONCLUSION Having patients and citizens actively participating in this research constitutes the main methodological strength. They enriched the study from start to finish, and recommended the addition of focus groups to seek the perspective of marginalized groups that are typically under-represented from digital health research. Clear communication of the project objectives, good organization in meetings, and continuous evaluation from participants allow best practices to be achieved for patients' and citizens' involvement in digital health research. Co-construction in research generates critical study design ideas through collective intelligence. This methodology can be used in various clinical contexts and different healthcare settings.
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Affiliation(s)
- Esli Osmanlliu
- Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, H2X 0A9, Canada
| | - Annie-Danielle Grenier
- DIGICIT Advisory Committee, Research Centre of the University of Montreal Hospital Centre, Montreal, QC, H2X 0A9, Canada
| | - Paul Lewis
- DIGICIT Advisory Committee, Research Centre of the University of Montreal Hospital Centre, Montreal, QC, H2X 0A9, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | - Sylvain Bédard
- Centre of Excellence for Partnership with Patients and the Public (CEPPP), Montreal, QC, H2X 0A9, Canada
| | - Marie-Pascale Pomey
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, H3N 1X9, Canada
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Clavel NC, Lavoie-Tremblay M, Biron A, Briand A, Paquette J, Bernard L, Fancott C, Pomey MP, Dumez V. Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology - NOSO-COVID study protocol. BMJ Open 2022; 12:e056172. [PMID: 35868827 PMCID: PMC9315236 DOI: 10.1136/bmjopen-2021-056172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Healthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders. DESIGN AND METHODS The proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders' perspectives on patient and family engagement in infection prevention. ETHICS AND DISSEMINATION The research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement.
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Affiliation(s)
| | | | - Alain Biron
- McGill University Health Centre, Montreal, Québec, Canada
| | - Anaick Briand
- McGill University Health Centre, Montreal, Québec, Canada
| | - Jesseca Paquette
- Ingram School of Nursing, McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Laurence Bernard
- Faculty of Nursing, University of Montreal, Montreal, Québec, Canada
| | - Carol Fancott
- Patient Engagement & Partnerships, Healthcare Excellence Canada, Ottawa, Ontario, Canada
| | | | - Vincent Dumez
- Centre of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
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25
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Massougbodji J, Zomahoun HTV, Adisso EL, Sawadogo J, Borde V, Cameron C, Moisan H, Paquette JS, Akbaraly Z, Châteauneuf LK, David G, David G, Légaré F. Scaling-up citizen workshops in public libraries to disseminate and discuss primary care research results: a quasi-experimental study. JMIR Aging 2022; 5:e39016. [PMID: 35690963 PMCID: PMC9440407 DOI: 10.2196/39016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the public. Objective Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program to disseminate research results in public libraries. Methods We conducted a scaling-up study targeting the public. On the basis of our successful pilot project, we codeveloped and implemented a large-scale program of free citizen workshops in public libraries, in a close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by 1 participating physician and 1 science communicator, consisted of a 45-minute computer-assisted presentation and a 45-minute open exchange. The intervention outcome was knowledge gained. The scale-up outcomes were satisfaction, appropriateness, coverage, and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results The workshop theme chosen by the patient and stakeholder representatives was the high prevalence of medication overuse among people aged ≥65 years. From April to May 2019, 26 workshops were conducted in 25 public libraries reaching 362 people. The mean age of participants was 64.8 (SD 12.5) years. In total, 18 participating physicians and 6 science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0-2.2; P<.001). The median score for overall public satisfaction was 9 out of 10 (IQR 8-10). The public participants globally rated the workshops as having a high level of appropriateness. Coverage was 92% (25/27) of the total number of public libraries targeted. Costs were CAD $6051.84 (US $4519.69) for workshop design and CAD $22,935.41 (US $17,128.85) for scaling them up. Conclusions This project successfully established a large-scale and successful implementation science or knowledge translation bridge among researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the public by both engaging them in the dissemination process and targeting them directly.
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Affiliation(s)
- José Massougbodji
- Department of Social and Preventive Medicine, Laval University, Québec, CA
| | | | | | - Jasmine Sawadogo
- First Nations of Quebec and Labrador Health and Social Services Commission, Québec, CA
| | | | - Cynthia Cameron
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, CA
| | | | | | - Zamzam Akbaraly
- Patient and public partnership research strategy component, Quebec SPOR-SUPPORT Unit, Laval University, Québec, CA
| | - Lëa-Kim Châteauneuf
- Direction des bibliothèques, Service de la culture - Ville de Montréal, Montreal, CA
| | - Geneviève David
- Centre de recherche du CHUM, Université de Montréal, Montreal, CA
| | - Geneviève David
- Centre de recherche du CHUM, Université de Montréal, Montreal, CA
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480, chemin de la Canardière, Quebec, CA
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Termoz A, Delvallée M, Damiolini E, Marchal M, Preau M, Huchon L, Mazza S, Habchi O, Bravant E, Derex L, Nighoghossian N, Cakmak S, Rabilloud M, Denis A, Schott AM, Haesebaert J. Co-design and evaluation of a patient-centred transition programme for stroke patients, combining case management and access to an internet information platform: study protocol for a randomized controlled trial - NAVISTROKE. BMC Health Serv Res 2022; 22:537. [PMID: 35459183 PMCID: PMC9027042 DOI: 10.1186/s12913-022-07907-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke affects many aspects of life in stroke survivors and their family, and returning home after hospital discharge is a key step for the patient and his or her relatives. Patients and caregivers report a significant need for advice and information during this transition period. Our hypothesis is that, through a comprehensive, individualised and flexible support for patients and their caregivers, a patient-centred post-stroke hospital/home transition programme, combining an Internet information platform and telephone follow-up by a case manager, could improve patients' level of participation and quality of life. METHODS An open parallel-group randomized trial will be conducted in two centres in France. We will recruit 170 adult patients who have had a first confirmed stroke, and were directly discharged home from the stroke unit with a modified Rankin score ≤3. Intervention content will be defined using a user-centred approach involving patients, caregivers, health-care professionals and social workers. Patients randomized to the intervention group will receive telephonic support by a trained case manager and access to an interactive Internet information platform during the 12 months following their return home. Patients randomized to the control group will receive usual care. The primary outcome is patient participation, measured by the "participation" dimension score of the Stroke Impact Scale 6 months after discharge. Secondary outcomes will include, for patients, quality of life, activation, care consumption, as well as physical, mental and social outcomes; and for caregivers, quality of life and burden. Patients will be contacted within one week after discharge, at 6 and 12 months for the outcomes collection. A process evaluation alongside the study is planned. DISCUSSION Our patient-centred programme will empower patients and their carers, through individualised and progressive follow-up, to find their way around the range of available healthcare and social services, to better understand them and to use them more effectively. The action of a centralised case manager by telephone and the online platform will make it possible to disseminate this intervention to a large number of patients, over a wide area and even in cases of geographical isolation. TRIAL REGISTRATION ClinicalTrials NCT03956160 , Posted: May-2019 and Update: September-2021.
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Affiliation(s)
- Anne Termoz
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - Marion Delvallée
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Eléonore Damiolini
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Mathilde Marchal
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Marie Preau
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | - Laure Huchon
- Médecine Physique et Réadaptation, Hospices Civils de Lyon, Hôpital Henry Gabrielle, Lyon, France
| | - Stéphanie Mazza
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Ouazna Habchi
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Estelle Bravant
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Norbert Nighoghossian
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Serkan Cakmak
- Service Neuro-vasculaire, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Muriel Rabilloud
- Service de Biostatistique et Bioinformatique Hospices Civils de Lyon Pôle Santé Publique, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Université Claude Bernard Lyon 1, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Angélique Denis
- Service de Biostatistique et Bioinformatique Hospices Civils de Lyon Pôle Santé Publique, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Université Claude Bernard Lyon 1, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Lessard-Deschênes C, Goulet MH. The therapeutic relationship in the context of involuntary treatment orders: The perspective of nurses and patients. J Psychiatr Ment Health Nurs 2022; 29:287-296. [PMID: 34551167 DOI: 10.1111/jpm.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment. The use of involuntary treatment orders can impact the nurse-patient therapeutic relationship, which is essential to offer quality care and promote recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility. Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship. Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse-patient therapeutic relationship. ABSTRACT: Introduction Involuntary treatment orders (ITO) can impact the nurse-patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method Secondary data analysis of qualitative interviews with nurses (n = 9) and patients (n = 6) was performed using content analysis. Results Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build.
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Affiliation(s)
- Clara Lessard-Deschênes
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
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Sibbald SL, Misra V, daSilva M, Licskai C. A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study. BMC Health Serv Res 2022; 22:420. [PMID: 35354444 PMCID: PMC8966237 DOI: 10.1186/s12913-022-07785-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 12/22/2022] Open
Abstract
Background In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. Methods We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.
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Affiliation(s)
- Shannon L Sibbald
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada. .,Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada.
| | - Vaidehi Misra
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada
| | - Madelyn daSilva
- Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada
| | - Christopher Licskai
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Porro B, Michel A, Cousson-Gélie F. Influence de la précarité sociale et du soutien social perçu, sur le retour au travail des femmes ayant un cancer du sein, dans l’année suivant le début des traitements adjuvants. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’objectif est d’étudier les liens entre précarité sociale, soutien social perçu et retour au travail (RAT) dans la première année suivant le début des traitements adjuvants du cancer du sein. Soixante-huit patientes incluses au début des traitements adjuvants (T0) ont été suivies à 3 (T1) et 12 mois (T2). Le soutien informatif des amis à T0 favorise le RAT à T1. La précarité et le soutien négatif à T0 et T2 sont des freins au RAT à T2. La prise en charge du RAT doit être proposée et adaptée dès le début des traitements.
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Ben Charif A, Zomahoun HTV, Gogovor A, Abdoulaye Samri M, Massougbodji J, Wolfenden L, Ploeg J, Zwarenstein M, Milat AJ, Rheault N, Ousseine YM, Salerno J, Markle-Reid M, Légaré F. Tools for assessing the scalability of innovations in health: a systematic review. Health Res Policy Syst 2022; 20:34. [PMID: 35331260 PMCID: PMC8943495 DOI: 10.1186/s12961-022-00830-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/16/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The last decade has seen growing interest in scaling up of innovations to strengthen healthcare systems. However, the lack of appropriate methods for determining their potential for scale-up is an unfortunate global handicap. Thus, we aimed to review tools proposed for assessing the scalability of innovations in health. METHODS We conducted a systematic review following the COSMIN methodology. We included any empirical research which aimed to investigate the creation, validation or interpretability of a scalability assessment tool in health. We searched Embase, MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and ERIC from their inception to 20 March 2019. We also searched relevant websites, screened the reference lists of relevant reports and consulted experts in the field. Two reviewers independently selected and extracted eligible reports and assessed the methodological quality of tools. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. RESULTS We identified 31 reports describing 21 tools. Types of tools included criteria (47.6%), scales (33.3%) and checklists (19.0%). Most tools were published from 2010 onwards (90.5%), in open-access sources (85.7%) and funded by governmental or nongovernmental organizations (76.2%). All tools were in English; four were translated into French or Spanish (19.0%). Tool creation involved single (23.8%) or multiple (19.0%) types of stakeholders, or stakeholder involvement was not reported (57.1%). No studies reported involving patients or the public, or reported the sex of tool creators. Tools were created for use in high-income countries (28.6%), low- or middle-income countries (19.0%), or both (9.5%), or for transferring innovations from low- or middle-income countries to high-income countries (4.8%). Healthcare levels included public or population health (47.6%), primary healthcare (33.3%) and home care (4.8%). Most tools provided limited information on content validity (85.7%), and none reported on other measurement properties. The methodological quality of tools was deemed inadequate (61.9%) or doubtful (38.1%). CONCLUSIONS We inventoried tools for assessing the scalability of innovations in health. Existing tools are as yet of limited utility for assessing scalability in health. More work needs to be done to establish key psychometric properties of these tools. Trial registration We registered this review with PROSPERO (identifier: CRD42019107095).
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Affiliation(s)
| | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine and Health Science, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | - Mamane Abdoulaye Samri
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - José Massougbodji
- Institut national de santé publique du Québec (INSPQ), Quebec City, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | | | - Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Canada Research Chair in Person Centred Interventions for Older Adults with Multimorbidity and their Caregivers, McMaster University, Hamilton, ON, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada.
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Martinet-Kosinski F. [COVID-19 pandemic: the "trolley problem" to explain allocation of scarce resources]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:803-811. [PMID: 35485010 DOI: 10.3917/spub.216.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The SARS-CoV-2 virus that appeared in December 2019 in the city of Wuhan in China spread rapidly. Severe forms of this virus infection cause acute respiratory distress syndromes (ARDS) requiring hospitalization of affected patients in intensive care units (IUCs), providing mechanical ventilation. The capacity of ICUs in the countries most affected by this health crisis quickly became overwhelmed, forcing healthcare providers to choose the patients who would benefit from care. Managing the overload of a healthcare system is the role of disaster medicine, for which one of the principles is the triage of patients according to their severity. Having to choose between patients means choosing a statement between deontology (judging the morality of an action according to its intention) and utilitarianism (judging the morality of an action by its consequences). AIM The aims of this article are, through the analysis of the trolley problem, to understand and justify the process of allocation of scarce resources found in the guidelines used in the context of the COVID-19 pandemic. RESULTS The analysis of the trolley problem allows us to understand in what way our choices are utilitarian or deontological. Saving as many lives as possible", as advocated in the guidelines, is utilitarian. CONCLUSIONS These answers will provide a better understanding of all of the different ways of allocating scare resources according to the deontological or utilitarian approach, especially the one found in the disaster medicine guidelines.
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Éducation thérapeutique du patient au cours de la réadaptation respiratoire. Rev Mal Respir 2022; 39:152-169. [DOI: 10.1016/j.rmr.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
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Merle R, Pépin JL, Palombi O, Pariset A, Allenet B, Pison C. Successful Training of Patients to Intervene in Health Education and Clinical Research at Grenoble Patient School. J Patient Exp 2022; 9:23743735211069810. [PMID: 35097188 PMCID: PMC8793428 DOI: 10.1177/23743735211069810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The primary goal of patient and public involvement (PPI) in healthcare is to improve individual and population health outcomes. This study reports on the successful training of patients to be involved in patient education as peers and clinical research at Grenoble Patients' School (GPS). GPS was founded by patients as an independent association to train patients to the above objectives tasks. The training team was multi-professional and included expert PPI who were part of the professional team. Medical faculty members and 45 patients, 59% females, 52 ± 6.4 years old, trained between 2016 and 2017, showed high satisfaction at the end of the training courses. Almost all the trained patients were involved as peer educators and 4 were involved in clinical research projects at different stages under the guidance of medical teams. Patient involvement at GPS provided strong benefits to trainees and had some impact on education and obtaining research grants. The outcome of this patient training program resulted in the creation of a Patients' Department within the Medical and Pharmacy Schools at the Université Grenoble Alpes in 2020, https://medecine.univ-grenoble-alpes.fr/departements/departement-universitaire-des-patients/.
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Affiliation(s)
- Raymond Merle
- Université Grenoble Alpes, Saint Martin d'Hères, Rhône-Alpes, France
- Laboratoire de Bioénergétique Fondamentale et Appliquée, Inserm1055, Saint Martin d'Hères, France
| | - Jean-Louis Pépin
- Université Grenoble Alpes, Saint Martin d'Hères, Rhône-Alpes, France
- Service Hospitalier Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
- Laboratoire HP2, Inserm1042, Grenoble, France
| | - Olivier Palombi
- Université Grenoble Alpes, Saint Martin d'Hères, Rhône-Alpes, France
- Service de Neurochirurgie, Pôle Appareil Locomoteur, Chirurgie réparatrice et Organes des sens, CHU Grenoble Alpes, Grenoble, France
- Laboratoire d'Anatomie des Alpes Françaises, Grenoble, France
- Université Numérique En Santé et Sport, UNESS, Paris, France
| | - Albane Pariset
- European Institute for Innovation and Technology Health France, Paris, France
| | - Benoît Allenet
- Université Grenoble Alpes, Saint Martin d'Hères, Rhône-Alpes, France
- Unité Transversale d'Education des Patients, CHU Grenoble Alpes, Grenoble, France
- ThEMAS, UMR CNRS 5525, CHU Grenoble Alpes, Grenoble, France
- Pharmacie Clinique, Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France
| | - Christophe Pison
- Université Grenoble Alpes, Saint Martin d'Hères, Rhône-Alpes, France
- Laboratoire de Bioénergétique Fondamentale et Appliquée, Inserm1055, Saint Martin d'Hères, France
- Service Hospitalier Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
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Seret J, Gooset F, Pirson M. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; 34:87-96. [PMID: 36102095 DOI: 10.3917/spub.221.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION One of the main recommendations to improve chronic asthmatic patients' adhesion to their treatment is the implementation of a coordinated care pathway aiming at facilitating disease management by the patient while meeting his needs and expectations. PURPOSE OF RESEARCH To study through a critical literature review and a short survey how this care pathway can be set up and adapted to the Belgian context. RESULTS A model including the three healthcare levels in Belgium was developed. The first level is mainly formed by general practitioners while the second and third are centralized around a structure called asthma clinic. This latter would provide a full asthma assessment, its chronic follow-up and treatment for severe asthma. Roles of healthcare professionals working with the asthmatic patient were identified and described. This model is discussed in the light of the present Belgian situation according to different plans: asthma management, effective interdisciplinary communication, advanced nurse practitioner's role implementation. CONCLUSION Although the Belgian context is currently not suitable enough for allowing this new nursing function to arise, our model lays the foundations of a system which is adapted to complexity of Belgium, follows from validated experiences on international scene, and offers an answer to chronic asthmatic patient's needs and expectations.
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Bernier L, Bernatchez S, Sweeney Beaudry A. L’avortement tardif et l’aide médicale à mourir au-delà de l’autonomie individuelle : comment réguler les pratiques pour assurer le vivre ensemble ? CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089781ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bansard E, Bouleuc C, Gaille M, Dolbeault S. Définir les soins de support : une contribution philosophique. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vingt ans après l’arrivée en France des soins de support, ce travail issu d’une thèse en philosophie sur les soins de support propose de faire le point sur leur définition et leur positionnement dans le système de soins. Il s’agit de décrire et de comprendre le flou conceptuel et la grande variété des offres de soins sur le territoire français et à l’international. En s’appuyant sur une analyse de la littérature et sur un travail de terrain, la place accordée aux patients en tant que partenaire des soins est proposée comme un fondement commun et structurant au sein de la diversité des pratiques. Nous interrogerons les liens entre la place des patients bénéficiant de soins de support et le modèle de « patient partenaire ». Là où le modèle dit « de Montréal » se réfère à un concept d’autonomie du patient, les soins de support proposent une attention et une adaptation à l’individu et à la fluctuation de ses besoins au cours du temps.
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Tannou T, Menand E, Veillard D, Contreras JB, Slekovec C, Daucourt V, Somme D, Corvol A. Geriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical audits. BMC Geriatr 2021; 21:705. [PMID: 34911444 PMCID: PMC8672546 DOI: 10.1186/s12877-021-02619-7] [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: 06/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background The international Choosing Wisely campaign seeks to improve the appropriateness of care, notably through large campaigns among physicians and users designed to raise awareness of the risks inherent in overmedication. Methods In deploying the Choosing Wisely campaign, the French Society of Geriatrics and Gerontology chose early operationalization via a tool for clinical audit over a limited area before progressive dissemination. This enabled validation of four consensual recommendations concerning the management of urinary tract infections, the prolonged use of anxiolytics, the use of neuroleptics in dementia syndromes, and the use of statins in primary prevention. The fifth recommendation concerns the importance of a dialogue on the level of care. It was written by patient representatives directly involved in the campaign. Results The first cross-regional campaign in France involved 5337 chart screenings in 43 health facilities. Analysis of the results showed an important variability in practices between institutions and significant percentage of inappropriate prescriptions, notably of psychotropic medication. Discussion The high rate of participation of target institutions shows that geriatrics professionals are interested in the evaluation and optimization of professional practices. Frequent overuse of psychotropic medication highlights the need of campaigns to raise awareness and encourage deprescribing.
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Affiliation(s)
- T Tannou
- Centre Hospitalier et Universitaire de Besançon, Service de Gériatrie, F-25000, Besançon, France. .,Centre Hospitalier et Universitaire de Besançon, INSERM CIC 1431, équipe "Ethique et progrès médical", F-25000, Besançon, France. .,Université de Franche-Comté, UFR des Sciences de la Santé, Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, F-25000, Besançon, France. .,Centre de recherche, Institut Universitaire de Gériatrie, Montréal, QC, Canada. .,Service de gériatrie, CHU de Besançon, Boulevard Fleming, 25030, Besancon, France.
| | - E Menand
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France
| | - D Veillard
- CAPPS, structure régionale d'appui à la qualité des soins et la sécurité des patients, Rennes, France.,Univ Rennes, CHU Rennes, Service de Santé Publique, F-35000, Rennes, France
| | - J Berthou Contreras
- OMéDIT, Observatoire du Médicament des Dispositifs médicaux et des Innovations Thérapeutiques, CHU de Besançon, Besançon, France
| | - C Slekovec
- CPIAS, Centre d'appui pour la Prévention des Infections Associées aux Soins Bourgogne-Franche-Comté, CHU de Besançon, Besançon, France
| | - V Daucourt
- RéQua, Structure régionale d'appui à la qualité des soins et la sécurité des patients, Besançon, France
| | - D Somme
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
| | - A Corvol
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
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Clavel N, Paquette J, Dumez V, Del Grande C, Ghadiri DP(S, Pomey M, Normandin L. Patient engagement in care: A scoping review of recently validated tools assessing patients' and healthcare professionals' preferences and experience. Health Expect 2021; 24:1924-1935. [PMID: 34399008 PMCID: PMC8628592 DOI: 10.1111/hex.13344] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/04/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient engagement in care is a priority and a key component of clinical practice. Different approaches to care have been introduced to foster patient engagement. There is a lack of a recent review on tools for assessing the main concepts and dimensions related to patient engagement in care. OBJECTIVE Our scoping review sought to map and summarize recently validated tools for assessing various concepts and dimensions of patient engagement in care. SEARCH STRATEGY A scoping review of recent peer-reviewed articles describing tools that assess preferences in and experience with patient engagement in care was conducted in four databases (Ovid Medline, Ovid EMBASE, Cochrane Database of Systematic Reviews, CINAHL-EBSCO). We adopted a broad definition based on the main concepts of patient engagement in care: patient-centredness, empowerment, shared decision-making and partnership in care. MAIN RESULTS Of 2161 articles found, 16, each describing a different tool, were included and analysed. Shared decision-making and patient-centredness are the two main concepts evaluated, often simultaneously in most of the tools. Only four scales measure patient-centredness, empowerment and shared decision-making at the same time, but no tool measures the core dimensions of partnership in care. Most of the tools did not include patients in their development or validation or just consulted them during the validation phase. DISCUSSION AND CONCLUSION There is no tool coconstructed with patients from development to validation, which can be used to assess the main concepts and dimensions of patient engagement in care at the same time. PATIENT AND PUBLIC CONTRIBUTION This manuscript was prepared with a patient expert who is one of the authors. Vincent Dumez, who is a patient expert and codirector of the Center of Excellence on Partnership with Patients and the Public, has contributed to the preparation of the manuscript.
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Affiliation(s)
- Nathalie Clavel
- Ingram School of NursingMcGill UniversityMontrealQuebecCanada
| | - Jesseca Paquette
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
| | - Vincent Dumez
- Center of Excellence on Partnership with Patients and the PublicUniversity of MontrealMontrealQuebecCanada
| | - Claudio Del Grande
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
- Department of Health Management, Evaluation and Policy, School of Public HealthUniversity of MontrealMontrealQuebecCanada
| | | | - Marie‐Pascale Pomey
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
- Center of Excellence on Partnership with Patients and the PublicUniversity of MontrealMontrealQuebecCanada
- Department of Health Management, Evaluation and Policy, School of Public HealthUniversity of MontrealMontrealQuebecCanada
| | - Louise Normandin
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
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Blanchette V, Plourde K, Côté I, Poulin G, Légaré F. Discussing around a virtual fire: Citizen engagement in a shared Decision-Making conference. Nurs Health Sci 2021; 24:78-82. [PMID: 34841642 DOI: 10.1111/nhs.12907] [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: 07/19/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
An online conference was organized to promote the Interprofessional Shared Decision-Making model and maximize its dissemination among stakeholders (citizens, health care providers, administrative staffs, policy makers, academics) in Canada. The goal was to enhance knowledge of and engagement in shared decision-making in a patient-oriented research, since shared decision-making has been hampered by reduced face-to-face contact, fear of infection, and overworked health professionals due to the COVID-19 pandemic. Therefore, we share a summary of what has been done to engage citizens in shared decision-making and to inform the interprofessional community about active citizen engagement in an online conference.
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Affiliation(s)
- Virginie Blanchette
- Department of Family and Emergency Medicine, Université Laval, VITAM - Centre de recherche en santé durable and Canada Research Chair in Shared Decision Making and Knowledge Translation, Québec City, Québec, Canada.,Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Karine Plourde
- Department of Family and Emergency Medicine, Université Laval, VITAM - Centre de recherche en santé durable and Canada Research Chair in Shared Decision Making and Knowledge Translation, Québec City, Québec, Canada
| | - Isabelle Côté
- VITAM-Centre de recherche en Santé durable, Québec City, Québec, Canada
| | - Guy Poulin
- VITAM-Centre de recherche en Santé durable, Québec City, Québec, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, VITAM - Centre de recherche en santé durable and Canada Research Chair in Shared Decision Making and Knowledge Translation, Québec City, Québec, Canada
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Aghnatios M, Darloy T, Dictor J, Gasparovicova M, Drouot C, Gasperini F, Bouchez T. [Advanced practice nursing: representations of actors in this new model]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2021; Vol. 33:547-558. [PMID: 35485111 DOI: 10.3917/spub.214.0547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Advanced practice nursing (APN) became legally established in France in 2018. Acquiring competences in the medical domain, an advanced practice nurse (APN) will follow willing patients referred by a physician. An assessment of this innovation's impact in the organization of French health care will be submitted to the French parliament in 2021. This research study was carried out to collect data with the intention of supporting the implementation of this model and constituting the starting point for the model's monitoring over time. PURPOSE OF RESEARCH To explore different actors' representations of the advanced practice nursing model pertaining to stabilized chronic diseases' management in primary health care, in the PACA (Provence-Alpes-Côte d'Azur region). Actors involved include patients, general practitioners, nurses and advanced practice nursing students. RESULTS In this prospective qualitative study based on grounded theory, 58 semi-structured individual interviews were conducted. Participants showed heterogeneous representations of the APN's role. They expressed vagueness about the model and pointed out the need for better communication to facilitate its integration. The monitoring of care plans, the home health care, the therapeutic education and prevention were identified as needs in which the APN could participate. Under-medicalized areas were suggested as suitable to its implementation. The main fear was the changes of the distribution of professional tasks with the risk of competition with other established positions. The APN's integration was perceived as easier in healthcare establishments as the roles seems well-defined there with less identity confusion between the various actors, unlike in the private ambulatory care sector. Collaboration among health actors was mentioned as a condition for the success of the APN model. A cautious attitude was noted and a need for a run-in period emerged, first APN being considered as precursors. CONCLUSIONS Mobilization of health actors is a criterion for successful integration of APN, therefore an awareness policy seems necessary. Training of health professionals in their curricula or in continuing education would make it possible to develop collaborative skills necessary for APN's integration.
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Maury A, Berkesse A, Lucas G, Mouriaux F, Allory E. [Integrating of patients as teachers in medical schools]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2021; Vol. 33:559-568. [PMID: 35485112 DOI: 10.3917/spub.214.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In a social context supportive of patient engagement throughout society, many scientific claims are in favour of developing patient engagement in medical education. However, few studies have objectively investigated current practices and the obstacles to patient engagement from the point of view of medical educators. PURPOSE OF RESEARCH This study aimed at investigating medical educators' practices regarding patient engagement, and their expectations and self reported obstacles. METHOD This study's design was observational, cross-sectional and monocentered. Survey responses were queried by email from 565 academic medical educators at the Rennes Medical School in 2019. Patient engagement was ranked in four levels based on Pomey's theoretical frame, ranging from use of health data to cocreation of training programs. RESULTS The response rate was 23% (N = 128). The educator's profiles were diverse in age, specialty and status. 35 declared involving patients in their teachings, 4 of them declared cocreating courses with the patients. The remaining 93 educators did not involve patients in their course and reported some obstacles. The main obstacles were: never thought about it (60%), difficulties selecting the patient (36%) and lack of time (21%). The patient's role as a teacher was not disregarded. CONCLUSIONS This first study about academic educator's perspectives toward patient engagement in medical training identified obstacles and pathways to promote patient engagement.
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Bourmaud A, Piot de Villars E, Renault-Teissier E. [Patient partnership and patient education in oncology]. Bull Cancer 2021; 109:588-597. [PMID: 34782118 DOI: 10.1016/j.bulcan.2021.09.016] [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: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 40years, the French health system has opened up to patient engagement. Society has recognised the legitimacy of the patient as a decision-maker in his or her own health and as an expert in his or her illness. This is true at the individual level in the context of doctor-patient relationship, and at the organisational level within institutions, in decision-making or academic groups. The aim of this study is to present the concepts of patient-partnership, patient education and to illustrate the different functions that patient-partners can take within the organisation of patient education programmes, and in the field of oncology. METHOD A narrative review of the literature was carried out to extract relevant and recent seminal articles to address these points. RESULTS The Montreal model establishes the patient partner as a full care actor. He can thus contribute his expertise in many fields of application: care, research or teaching. The aim of patient education is to empower the patient in the management of his or her disease, treatment and the consequences of these on daily life. The patient partner has a full place in this system where he can accompany his peers, but also collaborate with the educational team to develop new programmes, evaluate them and even conduct research. The implementation of these systems consists of getting individuals with different cultures and operating methods to work together. It is a process that requires time, effort and attention to each other.
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Affiliation(s)
- Aurelie Bourmaud
- Universitary hospital Robert-Debré, université de Paris, Clinical epidemiology unit, Inserm ECEVE, 1123 Paris, France.
| | | | - Evelyne Renault-Teissier
- Pain unit, DISSPO, douleur et soins palliatifs, universitary comprehensive cancer institut, Institut Curie, Paris, France
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Developing the first pan-Canadian survey on patient engagement in patient safety. BMC Health Serv Res 2021; 21:1099. [PMID: 34654420 PMCID: PMC8520305 DOI: 10.1186/s12913-021-07089-6] [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: 05/17/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety is a worldwide problem, and the patient contribution to mitigate the risk of patient harm is now recognized as a cornerstone to its solution. In order to understand the nature of integrating patients into patient safety and healthcare organizations and to monitor their integration, a Canadian survey tool has been co-constructed by patients, researchers and the Canadian Patient Safety Institute (CPSI). This questionnaire has been adapted from the French version of the patient engagement (PE) in patient safety (PS) questionnaire created for the province of Quebec, Canada. METHODOLOGY The pan-Canadian PE in PS survey tool was developed in a five-step process: (1) a literature review and revision of the initial tool developed in the province of Quebec; (2) translation of the French questionnaire into an English version tool; (3) creation of a Canadian expert advisory group; (4) adaptation of the English version tool based on feedback from the expert advisory group (assessment and development of the construct's dimensions, wording assessment and adaptation for pan-Canadian use, technical testing of the online platform for the survey); and (5) pilot testing and pre-validation of the tool before pan-Canadian use. RESULTS AND CONCLUSION Eight pan-Canadian PE in PS surveys were completed from five Canadian provinces by the expert advisory group and six surveys were completed during the pilot project by participants from different provinces in Canada. This survey tool comprises 5 sections: (1) demographic identification of the participants (Q1 to Q5); (2) general questions (Q6 to Q17); (3) the patient engagement process (experience level of participants and organizational incentives for PE in general) (Q18 to Q33); (4) PE in PS processes, such as current activities, strategies, structures, resources and factors (Q34 to Q67); and (5) the context and impact of PE in PS initiatives in Canadian healthcare organizations (CHOs) (Q68 to Q75), including outcome identification, improvement mechanisms and strategies, evaluation mechanisms, and indicators.
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Thonon B, Levaux MN, van Aubel E, Larøi F. A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment. Behav Modif 2021; 46:1167-1197. [PMID: 34583549 DOI: 10.1177/01454455211047605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.
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Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9091204. [PMID: 34574978 PMCID: PMC8466336 DOI: 10.3390/healthcare9091204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022] Open
Abstract
Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence.
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Pomey M, Clavel N, Normandin L, Del Grande C, Philip Ghadiri D, Fernandez‐McAuley I, Boivin A, Flora L, Janvier A, Karazivan P, Pelletier J, Fernandez N, Paquette J, Dumez V. Assessing and promoting partnership between patients and health-care professionals: Co-construction of the CADICEE tool for patients and their relatives. Health Expect 2021; 24:1230-1241. [PMID: 33949739 PMCID: PMC8369086 DOI: 10.1111/hex.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Partnership between patients and health-care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs. OBJECTIVE To co-construct a tool for measuring the degree of partnership between patients and HCPs. DESIGN The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co-construct the tool; (3) assess face and content validity from patients' and HCPs' viewpoints; and (4) assess the usability of the tool and explore its measurement performance. RESULTS The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise. Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity. CONCLUSIONS The CADICEE tool is developed in co-construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health-care settings. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in determining the importance of constructing this questionnaire. They co-constructed it, pre-tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.
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Affiliation(s)
- Marie‐Pascale Pomey
- School of Public HealthUniversity of MontrealMontrealQCCanada
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
| | | | - Louise Normandin
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | - Claudio Del Grande
- School of Public HealthUniversity of MontrealMontrealQCCanada
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | | | | | - Antoine Boivin
- Department of Family MedicineUniversity of MontrealMontrealQCCanada
| | - Luigi Flora
- Faculté de MédecineUniversité Nice Sophia AntipolisNiceFrance
| | - Annie Janvier
- Department of PediatricsUniversity of MontrealMontrealQCCanada
| | - Philippe Karazivan
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
- Department of ManagementHEC MontréalMontrealQCCanada
| | | | - Nicolas Fernandez
- Department of EducationUniversité du Québec à MontréalMontrealQCCanada
| | - Jesseca Paquette
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | - Vincent Dumez
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
- Faculty of MedicineUniversity of MontrealMontrealQCCanada
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Scholtes B, Breinbauer M, Rinnenburger M, Voyen M, Nguyen-Thi PL, Ziegler O, Germain L, Böhme P, Baumann M, Le Bihan E, Repplinger JJ, Spitz E, Voz B, Ortiz-Halabi I, Dardenne N, Donneau AF, Guillaume M, Bragard I, Pétré B. Hospital practices for the implementation of patient partnership in a multi-national European region. Eur J Public Health 2021; 31:73-79. [PMID: 32968807 DOI: 10.1093/eurpub/ckaa153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. METHODS A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. RESULTS Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. CONCLUSIONS Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context.
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Affiliation(s)
- Beatrice Scholtes
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Mareike Breinbauer
- Department of Sociology, Empirical Social Research and Methodology, Trier University, Trier, Germany
| | - Mirko Rinnenburger
- Department of Sociology, Empirical Social Research and Methodology, Trier University, Trier, Germany
| | - Madeline Voyen
- Department of Medical Evaluation and Information, University Hospital Centre, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Phi Linh Nguyen-Thi
- Department of Medical Evaluation and Information, University Hospital Centre, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Oliver Ziegler
- Department of Endocrinology, Diabetology, and Nutrition , Brabois Hospital, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Lucie Germain
- Department of Medical Evaluation and Information, University Hospital Centre, CHRU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Philip Böhme
- Department of Endocrinology, Diabetology, and Nutrition , Brabois Hospital, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,LORDIAMN Network, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
| | - Michèle Baumann
- Institute for Research on Sociology and Economic Inequalities (IRSEI) MSH, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Etienne Le Bihan
- Institute for Research on Sociology and Economic Inequalities (IRSEI) MSH, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Elisabeth Spitz
- Department of Health Psychology, APEMAC Unit, Université de Lorraine, Ile du Saulcy, Metz
| | - Bernard Voz
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Iness Ortiz-Halabi
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Nadia Dardenne
- Unit of Biostatistics, Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Anne-Françoise Donneau
- Unit of Biostatistics, Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Isabelle Bragard
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Benoit Pétré
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
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Osmanlliu E, Rafie E, Bédard S, Paquette J, Gore G, Pomey MP. Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review. JMIR Mhealth Uhealth 2021; 9:e27102. [PMID: 34038376 PMCID: PMC8191727 DOI: 10.2196/27102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. OBJECTIVE This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. METHODS Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. RESULTS A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. CONCLUSIONS Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps.
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Affiliation(s)
- Esli Osmanlliu
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Edmond Rafie
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Sylvain Bédard
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, QC, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
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Hansen TK, Jensen AL, Damsgaard EM, Rubak TMM, Jensen MEJ, Gregersen M. Involving frail older patients in identifying outcome measures for transitional care-a feasibility study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:36. [PMID: 34082836 PMCID: PMC8173811 DOI: 10.1186/s40900-021-00288-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND During care transitions, the older (75+) patient's agenda can easily be missed. To counteract this, involving patients in shared clinical decision making has proven to be of great value. Likewise, involving patients and other stakeholders as researchers is gaining ground. Patient and public involvement (PPI) in research entails many benefits, for example, by bringing further insight from those with lived experiences of being ill. There are various challenges associated with involving some older patients, for example frailty, cognitive impairment and other chronic illnesses. To the best of our knowledge, there are only a few examples of initiatives involving older patients beyond research participation. The feasibility of involving frail older patients during an ongoing care transition from hospital to primary health care remains unknown. To investigate the feasibility of including older frail patients, their relatives and health care professionals (HCPs) as co-researchers, we established a study with increasingly demanding levels of patient involvement to identify relevant outcome measures for future transitional care research. METHODS The study was a pragmatic, qualitative feasibility study. The involved individuals were frail older patients, their relatives and HCPs. Patients and their relatives were interviewed, while the interviewer made reflective notes. A thematic analysis was made. Relatives and HCPs discussed the themes to identify relevant outcome measures and potentially co-create new patient-reported outcome measures (PROMs) for use in future transitional care studies. The feasibility was evaluated according to six involvement steps. The level of involvement was evaluated using the five-levelled Health Canada Public Involvement Continuum (HCPIC). RESULTS In total, eight patients, five relatives and three HCPs were involved in the study. Patients were involved in discussing care transitions (HCPIC level 3), while some relatives were engaged (HCPIC level 4) in forming PROMs. The partnership level of involvement (HCPIC level 5) was not reached. The thematic analysis and the subsequent theme discussion successfully formed PROMs. The key PROMs were related to care, transparency and the relatives' roles in the transitional care process. CONCLUSIONS When applying a pragmatic involvement approach, frail older patients can be successfully involved in identifying relevant transitional care outcome measures; however, involving these patients as fellow researchers seems infeasible. To maintain involvement, supportive relatives are essential. Useful experiences for future research involvement of this vulnerable group were reported, arguing that patient participation has the potential to become inherent in future geriatric research.
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Affiliation(s)
- Troels Kjærskov Hansen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark.
| | - Annesofie Lunde Jensen
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | - Tone Maria Mørck Rubak
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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