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Blanchette V, Maranda-Pelletier S, Bilodeau G, Giguere A. Factors influencing the engagement of older adults with neurocognitive disorders in the design of decision aids: A qualitative descriptive study. Patient Educ Couns 2024; 119:108061. [PMID: 38035412 DOI: 10.1016/j.pec.2023.108061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To identify factors influencing the engagement of older adults with neurocognitive disorders (NCDs) in the design of decision aids (DAs). METHODS We conducted a qualitative descriptive study using semi-structured interviews with 23 older adults with NCDs who were accompanied by 27 caregivers. This is a secondary analysis of a published study to identify the features of DAs designed for this population and their caregivers. RESULTS Several behaviours and attitudes of caregivers and researchers hindered the older adults' engagement in the DA design process. Specific communication strategies can be employed to support their engagement and overcome the communication challenges inherent to this population, such as memory, attention, hearing, or visual impairments. Adopting the appropriate attitude, taking the time, and providing guidance to the older person can help them focus on the topic, while developing trust between participants is a facilitator to obtain their feedback. CONCLUSION Findings from this project could serve to inform the communication and co-design of DAs with older people with NCDs and their caregivers. PRACTICE IMPLICATIONS Caregivers and researchers have key roles to play in facilitating communication with older persons with NCDs so they are empowered to help in co-designing DAs.
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Affiliation(s)
- Virginie Blanchette
- VITAM - Research Centre on Sustainable Health, Quebec City, Canada; Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Sarah Maranda-Pelletier
- University Laval, Quebec City, Canada; School of Psychology, University Laval, Quebec City, Canada
| | | | - Anik Giguere
- VITAM - Research Centre on Sustainable Health, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
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Blanchette V, Todkar S, Brousseau-Foley M, Rheault N, Weisz T, Poitras ME, Paquette JS, Tremblay MC, Costa IG, Dogba MJ, Giguere A, de Mestral C, Légaré F. Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review. Can J Diabetes 2023; 47:682-694.e17. [PMID: 37437841 DOI: 10.1016/j.jcjd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. METHODS We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care. RESULTS Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. CONCLUSIONS Very few studies described patients' characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly managed type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada.
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec, affiliated with Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Trois-Rivières, Canada
| | - Nathalie Rheault
- Québec SSA Support Unit, Sherbrooke University, Longueil Campus, Longueuil, Québec, Canada
| | - Tom Weisz
- Patient Partner, Diabetes Action Canada, Toronto General Hospital, Toronto, Ontario, Canada; Patient Partner, Wounds Canada, North York, Ontario, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Saguenay, Québec, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Idevânia G Costa
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada; Canada Research Chair in Shared Decision-Making and Knowledge Translation, Québec, Canada
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Guay-Bélanger S, Aubin E, Cimon M, Archambault P, Blanchette V, Giguere A, Gogovor A, Morin M, Ben Charif A, Ben Gaied N, Bickerstaff J, Chénard N, Emond J, Gilbert J, Violet I, Légaré F. Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care. JMIR Res Protoc 2023; 12:e53150. [PMID: 37889512 PMCID: PMC10696497 DOI: 10.2196/53150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. OBJECTIVE This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. METHODS This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. RESULTS This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. CONCLUSIONS This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53150.
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Affiliation(s)
- Sabrina Guay-Bélanger
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Emmanuelle Aubin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anik Giguere
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Michèle Morin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | | | | | - Nancy Chénard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Emond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Gilbert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Isabelle Violet
- Ministère de la santé et des services sociaux du Québec, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Elliott J, Tong C, Gregg S, Mallinson S, Giguere A, Brierley M, Giosa J, MacNeil M, Juzwishin D, Sims-Gould J, Rockwood K, Stolee P. Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces. BMC Prim Care 2023; 24:199. [PMID: 37770822 PMCID: PMC10536733 DOI: 10.1186/s12875-023-02135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. METHODS A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. RESULTS Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. CONCLUSIONS COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, ON, Canada.
- St. Joseph's Health Care London, London, ON, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Catherine Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Susie Gregg
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sara Mallinson
- Alberta Health Services, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Laval, QC, Canada
| | | | - Justine Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Maggie MacNeil
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Don Juzwishin
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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5
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, Giangregorio L, Gibbs JC, Giguere A, Graham ID, Hankivsky O, Hoens AM, Holroyd-Leduc J, Kelly C, Moore JE, Ponzano M, Sharma M, Sibley KM, Straus S. Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Med Res Methodol 2022; 22:212. [PMID: 35927615 PMCID: PMC9351159 DOI: 10.1186/s12874-022-01682-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective. Methods We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights. Results We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08). Conclusions Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future. Trial registration Open Science Framework Registration: osf.io/qgh64. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01682-x.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | | | - Cole Etherington
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Olena Hankivsky
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Malika Sharma
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Giguere A, Holroyd-Leduc JM, Straus SE, Urquhart R, Turcotte V, Durand PJ, Turgeon A. Prioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces. BMC Geriatr 2022; 22:149. [PMID: 35197016 PMCID: PMC8864862 DOI: 10.1186/s12877-022-02843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02843-9.
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Affiliation(s)
- Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada. .,Quebec Excellence Centre on Aging, Quebec, Canada. .,VITAM - Research Centre on Sustainable Health (Centre de recherche en santé durable), 2480, chemin de la Canardière, QC, G1J 0A4, Québec, Canada.
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | - Pierre J Durand
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Division of Critical Care Medicine, CHU de Quebec - Université Laval Research Centre, Université Laval, Quebec, Canada
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8
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Tremblay Z, Mumbere D, Laurin D, Sirois C, Furrer D, Poisblaud L, Carmichael PH, Farrell B, Tourigny A, Giguere A, Vedel I, Morais J, Kröger E. Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2021; 10:e25200. [PMID: 34889771 PMCID: PMC8704115 DOI: 10.2196/25200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions. Objective This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ≥60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing. Methods Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2). Results The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes. Conclusions This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866 International Registered Report Identifier (IRRID) PRR1-10.2196/25200
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Affiliation(s)
- Zoë Tremblay
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - David Mumbere
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | | | | | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Lise Poisblaud
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Barbara Farrell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Anik Giguere
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
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9
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Yen RW, Smith J, Engel J, Muscat DM, Smith SK, Mancini J, Perestelo-Pérez L, Elwyn G, O'Malley AJ, Leyenaar JK, Mac O, Cadet T, Giguere A, Housten AJ, Langford A, McCaffery K, Durand MA. A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IDPAS). Med Decis Making 2021; 41:870-896. [PMID: 34151614 PMCID: PMC8763253 DOI: 10.1177/0272989x211020317] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. PURPOSE To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. DATA SOURCES MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. STUDY SELECTION Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. DATA EXTRACTION Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. DATA SYNTHESIS Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. LIMITATIONS Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. CONCLUSIONS PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective.[Box: see text].
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sian K Smith
- University of Bath, School of Management, Bath, Somerset, UK
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d'Azu, France
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha Langford
- New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
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10
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Muscat DM, Smith J, Mac O, Cadet T, Giguere A, Housten AJ, Langford AT, Smith S, Durand MA, McCaffery K. Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:848-869. [PMID: 34053361 DOI: 10.1177/0272989x211011101] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. PURPOSE An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. DATA SOURCES Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). STUDY SELECTION RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). DATA EXTRACTION Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. DATA SYNTHESIS Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%). LIMITATIONS We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health. New York, NY, USA
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- Université Toulouse III Paul Sabatier, Toulouse, France.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Suisse.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Bath Centre for Healthcare Innovation and Improvement, Information Decisions and Operations, School of Management, University of Bath, Somerset, UK
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11
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Lawani MA, Turgeon Y, Côté L, Légaré F, Witteman HO, Morin M, Kroger E, Voyer P, Rodriguez C, Giguere A. User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study. BMC Med Inform Decis Mak 2021; 21:59. [PMID: 33596874 PMCID: PMC7888116 DOI: 10.1186/s12911-021-01396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers. METHODS In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention. RESULTS Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice. CONCLUSIONS A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Yves Turgeon
- CISSS de la Gaspésie – Service externe de gériatrie ambulatoire, 455 rue Mgr Ross Est, Chandler, QC G0C 1K0 Canada
| | - Luc Côté
- Laval University, Pavillon Ferdinand-Vandry, Room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - France Légaré
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Holly O. Witteman
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre in Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, Room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Departmentof Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - Anik Giguere
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
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12
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Lorbergs A, Prorok J, Holroyd-Leduc J, Bouchard D, Giguere A, Gramlich L, Keller H, Tang A, Racey M, Ali M, Fitzpatrick-Lewis D, Sherifali D, Kim P, Muscedere J. Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty. J Frailty Aging 2021; 11:3-11. [DOI: 10.14283/jfa.2021.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions. Methods: We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes. Results: Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions. Interpretation: Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.
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13
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Joseph-Williams N, Abhyankar P, Boland L, Bravo P, Brenner AT, Brodney S, Coulter A, Giguere A, Hoffman A, Körner M, Langford A, Légaré F, Matlock D, Moumjid N, Munro S, Dahl Steffensen K, Stirling C, van der Weijden T. What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration. Med Decis Making 2020; 41:907-937. [PMID: 33319621 PMCID: PMC8474331 DOI: 10.1177/0272989x20978208] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting. AIM This review was conducted in response to the IPDAS Collaboration's evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. METHODS Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research. RESULTS We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve. CONCLUSIONS We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.
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Affiliation(s)
| | - Purva Abhyankar
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Laura Boland
- The Ottawa Hospital Research Institute, School of Health Sciences, Ottawa, Canada and Western University, School of Health Studies, London, ON, Canada
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, University of North Carolina Medical School, Chapel Hill, NC, USA, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne Brodney
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Aubri Hoffman
- Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs University, Freiburg, Germany
| | - Aisha Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université of Laval, Quebec, Canada
| | - Daniel Matlock
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Nora Moumjid
- Claude Bernard Lyon 1 University, Léon Bérard Cancer Centre, Lyon, Rhone-Alpes, France
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Region of Southern Denmark and Department of Clinical Oncology, Vejle/Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark and Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Trudy van der Weijden
- CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Faculty Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
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14
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Giroux D, Tremblay M, Latulippe K, Provencher V, Poulin V, Giguere A, Dubé V, Sévigny A, Guay M, Ethier S, Carignan M. Promoting Identification and Use of Aid Resources by Caregivers of Seniors: Co-Design of an Electronic Health Tool. JMIR Aging 2019; 2:e12314. [PMID: 31518284 PMCID: PMC6744817 DOI: 10.2196/12314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The importance of supporting caregivers is recognized in home care for older persons, and facilitating their help-seeking process is a way to meet that need. The use of electronic health (eHealth) is a potentially promising solution to facilitate caregivers' help-seeking process. OBJECTIVE The aim of this research was to develop, in partnership with community organizations, health and social service professionals and caregivers, an eHealth tool promoting the earlier identification of needs of older persons and an optimal use of available resources. METHODS To design the tool, 8 co-design sessions (CoDs) were conducted and 3 advisory committees were created (in 11 regions) in Quebec between May 2017 and May 2018. A variety of methods were used, including the sorting method, the use of personas, eHealth tool analysis, brainstorming, sketching, prototyping, and pretesting. RESULTS A total of 74 co-designers (women n=64 and men n=10) were recruited to participate in the CoDs or the advisory committees. This number allowed for the identification of needs to which the tool must respond and for the identification of its requirements (functionalities and content), as well as for the development of the information architecture. Throughout the study, adjustments were made to the planning of CoD, notably because certain steps required more sessions than expected. Among others, this was true for the identification of functionalities. CONCLUSIONS This study led to the development of an eHealth tool for caregivers of functionally dependent older persons to help them identify their needs and the resources available to meet them. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11634.
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Affiliation(s)
- Dominique Giroux
- Department of Rehabilitation, Université Laval, Québec, QC, Canada.,Center of Excellence on Aging Quebec, Québec, QC, Canada
| | - Mélanie Tremblay
- Department of Teaching and Learning Studies, Université Laval, Québec, QC, Canada
| | - Karine Latulippe
- Department of Teaching and Learning Studies, Université Laval, Québec, QC, Canada
| | - Véronique Provencher
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center of Research on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Valérie Poulin
- Université du Québec in Trois-Rivières, Trois-Rivières, QC, Canada.,Interdisciplinary Center for Research in Rehabilitation and Social Integration, Université Laval, Québec, QC, Canada
| | - Anik Giguere
- Center of Excellence on Aging Quebec, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Véronique Dubé
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.,Research Centre of the University Hospital of Montreal, Montréal, QC, Canada
| | - Andrée Sévigny
- Center of Excellence on Aging Quebec, Québec, QC, Canada.,School of Social Work and Criminology, Université Laval, Québec, QC, Canada
| | - Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center of Research on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Sophie Ethier
- Center of Excellence on Aging Quebec, Québec, QC, Canada.,School of Social Work and Criminology, Université Laval, Québec, QC, Canada
| | - Maude Carignan
- Center of Excellence on Aging Quebec, Québec, QC, Canada
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15
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Andrew MK, Dupuis-Blanchard S, Maxwell C, Giguere A, Keefe J, Rockwood K, St John P. Social and societal implications of frailty, including impact on Canadian healthcare systems. J Frailty Aging 2019; 7:217-223. [PMID: 30298169 DOI: 10.14283/jfa.2018.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults' health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecology framework to consider the social and societal implications and impact of frailty at each level, from the individual, through relationships with family and friend caregivers, institutions, health systems, neighborhoods and communities, to society at large. We conclude by arguing that attention to these issues at a policy level is critical. We identify three target actions: 1) Social dimensions of frailty should be systematically considered when frailty is assessed. 2) Action is needed at the level of policies and programs to improve support for caregivers. 3) Policy review across all portfolios will benefit from a social frailty lens.
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Affiliation(s)
- M K Andrew
- Melissa K Andrew, Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5155 Veterans' Memorial Lane, Halifax NS, B3H 2E1, , phone: (902) 473-4995, fax: (902) 473-1050
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Athale A, Giguere A, Barbara A, Krassova S, Iorio A. Developing a two-sided intervention to facilitate shared decision-making in haemophilia: decision boxes for clinicians and patient decision aids for patients. Haemophilia 2014; 20:800-6. [PMID: 25273544 DOI: 10.1111/hae.12495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with haemophilia face many treatment decisions, which are largely informed by evidence from observational studies. Without evidence-based 'best' treatment options, patient preferences play a large role in decisions regarding therapy. The shared decision-making (SDM) process allows patients and health care providers to make decisions collaboratively based on available evidence, and patient preferences. Decision tools can help the SDM process. The objective of this project was to develop two-sided decision tools, decision boxes for physicians and patient decision aids for patients, to facilitate SDM for treatment decisions in haemophilia. METHODS Development of the decision tools comprised three phases: topic selection, prototype development and usability testing with targeted end-users. Topics were selected using a Delphi survey. Tool prototypes were based on a previously validated framework and were informed by systematic literature reviews. Patients, through focus groups, and physicians, through interviews, reviewed the prototypes iteratively for comprehensibility and usability. RESULTS The chosen topics were: (i) prophylactic treatment: when to start and dosing, (ii) choosing factor source and (iii) immunotolerance induction: when to start and dosing. Intended end users (both health care providers and haemophilia patients and caregivers) were engaged in the development process. Overall perception of the decision tools was positive, and the purpose of using the tools was well received. CONCLUSIONS This study demonstrates the feasibility of developing decision tools for haemophilia treatment decisions. It also provides anecdotal evidence of positive perceptions of such tools. Future directions include assessment of the tools' practical value and impact on clinical practice.
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Affiliation(s)
- A Athale
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada
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Giguere A, Labrecque M, Grad R, Cauchon M, Greenway M, Légaré F, Pluye P, Turcotte S, Dolovich L, Haynes RB. Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol. BMC Med Inform Decis Mak 2012; 12:85. [PMID: 22867107 PMCID: PMC3472191 DOI: 10.1186/1472-6947-12-85] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 07/23/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment. METHODS/DESIGN A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians' intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians' access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs. CONCLUSIONS This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
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Affiliation(s)
- Anik Giguere
- Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada
| | - Michel Labrecque
- Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada
| | - Michel Cauchon
- Dept. of Family and Emergency Medicine, Laval University Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, Local 4617, Québec (QC), G1V 0A6, Canada
| | - Matthew Greenway
- Department of Family Medicine, McMaster University, 118 Lake Street, Saint-Catharines, ON, Canada
| | - France Légaré
- Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal (QC), H2W 1 S4, Canada
| | - Stephane Turcotte
- Research Center of the CHUQ, Saint-Francois d'Assise Hospital, 10 rue de l'Espinay, D6-730, Quebec City (QC), G1L 3 L5, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada
| | - R Brian Haynes
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, DeGroote School of Medicine, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, Canada
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Giguere A, Légaré F, Grad R, Pluye P, Haynes RB, Cauchon M, Rousseau F, Alvarez Argote J, Labrecque M. Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience. Implement Sci 2012; 7:72. [PMID: 22862935 PMCID: PMC3533695 DOI: 10.1186/1748-5908-7-72] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. METHODS Seven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb's seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings. RESULTS Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users' first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes' purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool's purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients. CONCLUSION Results will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.
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Affiliation(s)
- Anik Giguere
- Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139 1280 Main Street, West Hamilton, ON L8S 4 K1, Canada.
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Allaire AS, Labrecque M, Giguere A, Gagnon MP, Légaré F. What motivates family physicians to participate in training programs in shared decision making? J Contin Educ Health Prof 2012; 32:98-107. [PMID: 22733637 DOI: 10.1002/chp.21132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Little is known about the factors that influence family physician (FP) participation in continuing professional development (CPD) programs in shared decision making (SDM). We sought to identify the factors that motivate FPs to participate in DECISION+, a CPD program in SDM. METHODS In 2007-2008, we collected data from 39 FPs who participated in a pilot randomized trial of DECISION+. In 2010, we collected data again from 11 of those participants and from 12 new subjects. Based on the theory of planned behavior, our questionnaire assessed FPs' intentions to participate in a CPD program in SDM and evaluated FPs' attitudes, subjective norms and perceived behavioral control. We also conducted 4 focus groups to explore FPs' salient beliefs. RESULTS In 2010, FPs' mean intention to participate in a CPD program in SDM was relatively strong (2.6 ± 0.5 on a scale from -3 = "strongly disagree" to +3 = "strongly agree"). Affective attitude was the only factor significantly associated with intention (r = .51, p = .04). FPs identified the attractions of participating in a CPD program in SDM as (1) its interest, (2) the pleasure of learning, and (3) professional stimulation. Facilitators of their participation were (1) a relevant clinical topic, (2) an interactive program, (3) an accessible program, and (4) decision support tools. DISCUSSION To attract FPs to a CPD program in SDM, CPD developers should make the program interesting, enjoyable, and professionally stimulating. They should choose a clinically relevant topic, ensure that the program is interactive and accessible, and include decision support tools.
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Affiliation(s)
- Anne-Sophie Allaire
- Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, G1L 3L5, Canada
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Giguere A, Anas A, Nasser T, Hassan MH, Ahmed U, Beejay N, Nouh M, Khalowf M, Saleh A, Khan A, Attia M, El-Azab G. Treatment of hepatitis C virus infection in patients on maintenance hemodialysis: a single United Arab Emirates center experience. Eur J Intern Med 2011; 22:582-6. [PMID: 22075284 DOI: 10.1016/j.ejim.2011.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/01/2011] [Accepted: 05/15/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hepatitis C is prevalent among hemodialysis patients. In patients with normal kidney function, treatment with pegylated interferon and ribavirin can lead to eradication of HCV (hepatitis C virus). But the treatment is more problematic in patients with impaired kidney function, in part due to the altered pharmacokinetics of these medications. Despite recent guidelines, the optimal strategy in this group of patients is not well defined. METHOD In a retrospective study, we reviewed all patients with chronic hepatitis C on hemodialysis treated at Sheikh Khalifa Medical City, in the United Arab Emirates between 2003 and 2009. The aim of our study was to determine the rate of sustained viral response (SVR) and to establish the safety and rate of dropouts in the different treatment regimens used (patients treated with peginterferon only and patients treated with peginterferon and low dose ribavirin). RESULTS 22 patients were treated during this period. 5 patients received monotherapy with a reduced dose of peginterferon alfa 2b s.c. once weekly while 17 patients were treated with a combination of reduced dose of peginterferon alfa 2a or 2b s.c. once weekly and a low dose ribavirin (200mg/day). A SVR was achieved in 73% (16/22 patients) of the total patient population and in 76% (13/17 patients) in the sub-group of patients treated with a combination therapy. The tolerability was high. No patients had to discontinue their treatment. The use of ESA (erythropoietin stimulating agents) and G-CSF was common in the combination therapy (94% and 53% respectively). CONCLUSION In our study of patients on hemodialysis with chronic hepatitis C, the use of peginterferon or a combination of peginterferon with a low daily dose of ribavirin achieved a high rate of SVR and the rate of dropout was low after pursuing an aggressive management of side effects.
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Affiliation(s)
- A Giguere
- Sheikh Khalifa Medical City, Division of Gastroenterology, Abu Dhabi, UAE.
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Giguere A, Legare F, Grad R, Pluye P, Rousseau F, Haynes RB, Cauchon M, Labrecque M. Developing and user-testing Decision boxes to facilitate shared decision making in primary care--a study protocol. BMC Med Inform Decis Mak 2011; 11:17. [PMID: 21385470 PMCID: PMC3060840 DOI: 10.1186/1472-6947-11-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 03/09/2011] [Indexed: 11/10/2022] Open
Abstract
Background Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users. Methods/Design We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable), and will include new themes suggested by the data (inductive analysis). Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings. Discussion This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It is the first step in the development and implementation of a new tool that should facilitate decision making in clinical practice.
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Affiliation(s)
- Anik Giguere
- Research Center of the CHUQ, Saint-Francois d'Assise Hospital, and Department de médecine familliale, University Laval, Quebec City, Canada.
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Méndez M, Carvajal J, Cesteros Y, Marsal L, Martínez-Ferrero E, Giguere A, Drouin D, Salagre P, Formentín P, Pallarès J, Aguiló M, Díaza F. Photoluminescence and cathodoluminescence of Eu: La2O3 nanoparticles synthesized by several methods. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.phpro.2010.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Giguere A. [The capitalist development of regions and labor force mobility in Quebec, from 1966 to 1976]. Sociol Soc 1987; 19:117-31. [PMID: 12315208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
"In this paper the author presents a study of the spatial mobility of the Quebec population between 1966 and 1976, in the light of regional capitalist development. Based on an empirical operationalization of the concepts of mobility and development, the author demonstrates that Quebec presents a very irregular distribution of its poles of development over its territory, and that the mobility of the work force is in the image of this distribution. A few regions within the Montreal metropolitan area have attained a relatively evolved state of capitalist development and consequently are able to attract within their limits a large majority of migrants moving inside of or toward Quebec. In contrast, it can be observed that the majority of the regions in Quebec may be qualified as 'underdeveloped', and that their net mobility figures are negative." (SUMMARY IN ENG AND SPA)
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