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Rao S, Dimitropoulos G, Jardine R, Quickstad J, Satam L, Qureshi M, Bui T, Todorova AA, Tumaneng Y, Suthakaran A, Dalley K, Smith S, Patten SB. Primus Inter PARES: First among equals-practical strategies for young adult PAtient RESearch partners (PARES) by young adult PARES. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:45. [PMID: 38720386 PMCID: PMC11077772 DOI: 10.1186/s40900-024-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. MAIN BODY The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. CONCLUSION This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada.
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Rae Jardine
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Julien Quickstad
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Laetitia Satam
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Mohammad Qureshi
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Thyra Bui
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Antoaneta Alexandrova Todorova
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ysabelle Tumaneng
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Abitha Suthakaran
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Kaiden Dalley
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Stacie Smith
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Sanchez S, Thorburn R, Rea M, Kaufman P, Schwartz R, Selby P, Chaiton M. A systematic review of theories, models and frameworks used for youth engagement in health research. Health Expect 2024; 27:e13975. [PMID: 39102670 PMCID: PMC10825621 DOI: 10.1111/hex.13975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Youth engagement in research, wherein youth are involved in the research beyond mere participation as human subjects, is growing and becoming more popular as an approach to research. However, systematic and deliberate theory-building has been limited. We conducted a systematic review to identify and synthesize theories, models and frameworks that have been applied in the engagement of youth in health research, including mental health. METHODS Six academic databases (MEDLINE, PsycINFO, Embase, PubMed, Scopus, CINAHL) and the grey literature were searched for relevant studies. Citation tracking was conducted through ancestry and descendancy searches. The final search was completed on 7 February 2023. Findings were summarized in a narrative synthesis informed by principles of hermeneutic analysis and interpretation. Reporting of results is in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 Statement. RESULTS Of the 1156 records identified, 16 papers were included, from which we extracted named theories (n = 6), implicit theories (n = 5) and models and frameworks (n = 20) used for youth engagement in health research. We identified theories that were explicitly stated and surfaced theories that were more implicitly suggested. Models and frameworks were organized into four categories based on their principal features: power-focused (n = 8), process-focused (n = 7), impact-focused (n = 3) and equity-focused (n = 2). Few frameworks (n = 5) were empirically tested in health-related research. CONCLUSIONS The state of theoretical development in youth engagement in research is still evolving. In this systematic review, we identified theories, models and frameworks used for youth engagement in health research. Findings from this systematic review offer a range of resources to those who seek to develop and strengthen youth engagement in their own research. PATIENT OR PUBLIC CONTRIBUTION Youth engaged as patients in the research were not involved in planning or conducting the systematic review. However, youth researchers in their early to mid-20s led the planning, implementation and interpretation of the review. As part of subsequent work, we formed a youth advisory board to develop a youth-led knowledge mobilization intended for an audience of youth with lived experience of being engaged as patients in research.
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Affiliation(s)
- Sherald Sanchez
- Institute of Medical Science, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Ontario Tobacco Research Unit, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Rachel Thorburn
- Department of Applied Psychology and Human DevelopmentUniversity of TorontoTorontoOntarioCanada
- Centre for Addiction and Mental HealthInstitute for Mental Health Policy ResearchTorontoOntarioCanada
| | - Marika Rea
- Centre for Criminology and Sociolegal StudiesUniversity of TorontoTorontoOntarioCanada
| | - Pamela Kaufman
- Ontario Tobacco Research Unit, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Centre for Addiction and Mental HealthInstitute for Mental Health Policy ResearchTorontoOntarioCanada
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Centre for Addiction and Mental HealthInstitute for Mental Health Policy ResearchTorontoOntarioCanada
| | - Peter Selby
- Institute of Medical Science, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Centre for Addiction and Mental HealthInstitute for Mental Health Policy ResearchTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Michael Chaiton
- Institute of Medical Science, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Ontario Tobacco Research Unit, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Centre for Addiction and Mental HealthInstitute for Mental Health Policy ResearchTorontoOntarioCanada
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Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Zibrowski E, Carr T, McDonald S, Thiessen H, van Dusen R, Goodridge D, Haver C, Marciniuk D, Stobart C, Verrall T, Groot G. A rapid realist review of patient engagement in patient-oriented research and health care system impacts: part one. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:72. [PMID: 34629118 PMCID: PMC8504114 DOI: 10.1186/s40900-021-00299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patient-oriented research affords individuals with opportunities to genuinely contribute to health care research as members of research teams. While checklists and frameworks can support academic researchers' awareness of patient engagement methods, less guidance appears available to support their understanding of how to develop and maintain collaborative relationships with their patient partners. This knowledge is essential as patient partners report that the social atmospheres of research teams significantly impacts the quality of their experiences. This study sought to develop theory regarding how academic researchers support and sustain patient engagement in patient-oriented research. METHODS A six-step, rapid realist review was conducted: (1) research question development, (2) preliminary theory development, (3) search strategy development; (4) study selection and appraisal, (4) data extraction, analysis and synthesis (5) identification of relevant formal theories, and (6) theory refinement with stakeholders. Findings were additionally distilled by collective competence theory. RESULTS A program theory was developed from 62 international studies which illuminated mechanisms supporting academic researchers to engage patient partners, contexts supporting these mechanisms, and resources that enabled mechanism activation. Interaction between seven contexts (patient-oriented research belief, prior interaction with a healthcare system, prior interaction with a particular academic researcher, educational background of patient partner, prior experience with patient-oriented research, study type, and time lived in a rural-urban setting) and seven mechanisms (deciding to become involved in patient-oriented research, recognizing valuable experiential knowledge, cultural competence, reducing power differentials, respectful team environment, supporting patient partners to feel valued, and readiness to research) resulted in an intermediate outcome (sense of trust). Trust then acted as an eighth mechanism which triggered the final-level outcome (empowered patient-centred lens). CONCLUSIONS Our theory posits that if patient partners trust they are a member of a supportive team working alongside academic researchers who authentically want to incorporate their input, then they are empowered to draw upon their experiential knowledge of health care systems and contribute as researchers in patient-oriented research. Our theory extends conceptual thinking regarding the importance of trust on patient-oriented research teams, how patient partners' trust is shaped by team interactions, and the role that academic researchers have within those interactions.
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Affiliation(s)
- Elaine Zibrowski
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | | | | | | | - Donna Goodridge
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Charlene Haver
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Darcy Marciniuk
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Christine Stobart
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tanya Verrall
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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Azizian AR, Carr T, Muhajarine N, Verrall T, Hartness C, Vanstone J, Yasinian M, Skrapek C, Andreas B, Farthing G, Groot G. Developing a patient-oriented realist evaluation for COVID-19 vaccine implementation in Saskatchewan: a methodologic framework. CMAJ Open 2021; 9:E1034-E1039. [PMID: 34815258 PMCID: PMC8612651 DOI: 10.9778/cmajo.20210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is an urgent need to inform decision-making and safe delivery of vaccines in a timely manner. Our objective is to describe the methods we used to perform a patient-oriented realist evaluation of COVID-19 vaccination implementation in Saskatchewan, Canada, in order to understand the underlying mechanisms and contexts of vaccination implementation and vaccine uptake. METHODS This methodology paper describes a patient-oriented, realist, mixed-method evaluation to assess COVID-19 vaccination implementation in Regina, Saskatoon and Prince Albert, Saskatchewan. The study comprised 3 iterative phases guided by Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II). In phase 1 (January-February 2021), we developed the initial program theory, in phase 2 (March-May 2021), we tested and refined the initial program theory, and in phase 3 (June-July 2021), we established the final program theory. Three patient and family partners with different backgrounds and experiences were selected purposively from various locations (urban and rural) in Saskatchewan to engage collaboratively in the evaluation. Data analysis and synthesis occurred at all 3 phases of the project. We analysed qualitative data from phases 2 and 3 using a "retroductive" approach. We used quantitative data to compare outcomes from the 3 sites. INTERPRETATION This protocol describes how we developed a final program theory for COVID-19 vaccination implementation with patient and family partners to show for whom, under what circumstances, how and why Saskatchewan's COVID-19 vaccination program has led to vaccine uptake. With patient and family partners' engagement, the evaluation findings will be shared with the Saskatchewan Health Authority and provincial government policy-makers and communications departments, published in peer-reviewed journals, presented at provincial or national conferences, and disseminated through any additional media identified by the patient and family partners.
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Affiliation(s)
- Amir Reza Azizian
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Tracey Carr
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Tanya Verrall
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Collin Hartness
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Jason Vanstone
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Maryam Yasinian
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Candace Skrapek
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Brenda Andreas
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Gerald Farthing
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Gary Groot
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask.
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