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Décary S, de Wit M, Naye F, Barton JL, Fraenkel L, Li LC, Brooks P, Stacey D, Maxwell LJ, Campbell W, Hofstetter C, Voshaar M, Meara A, Christensen R, Boonen A, Suarez-Almazor ME, Meade T, March L, Jull JE, Alten R, Morgan EM, Stewart Hazlewood G, Barber CEH, Guillemin F, El-Miedany Y, Mittoo S, Robertson TW, Bartlett SJ, Singh JA, Mannion M, Nasef SI, Boel A, Adebajo A, Arnaud L, Gill TK, Moholt E, Burt J, Jayatilleke A, Hmamouchi I, Berthelsen DB, Blanco FJ, Mather K, Maharaj A, Sharma S, Caso F, Beaton D, Shea B, Fong C, Fernandez AP, Mackie S, Nikiphorou E, Jones A, Greer-Smith R, Sloan VS, Akpabio A, Strand V, Lee RR, Umaefulam V, Monti S, Abaza N, Schultz G, Stones S, Gossec L, Nielsen SM, Cavallo S, Srinivasalu H, Constien D, Evans V, Tugwell P, Toupin-April K. Consensus on the definitions and descriptions of the domains of the OMERACT Core Outcome Set for shared decision making interventions in rheumatology trials. Semin Arthritis Rheum 2024; 65:152381. [PMID: 38306813 DOI: 10.1016/j.semarthrit.2024.152381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To gain consensus on the definitions and descriptions of the domains of the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials evaluating shared decision making (SDM) interventions. METHODS Following the OMERACT Handbook methods, our Working Group (WG), comprised of 90 members, including 17 patient research partners (PRPs) and 73 clinicians and researchers, had six virtual meetings in addition to email exchanges to develop draft definitions and descriptions. The WG then conducted an international survey of its members to gain consensus on the definitions and descriptions. Finally, the WG members had virtual meetings and e-mail exchanges to review survey results and finalize names, definitions and descriptions of the domains. RESULTS WG members contributed to developing the definitions. Fifty-two members representing four continents and 13 countries completed the survey, including 15 PRPs, 33 clinicians and 37 researchers. PRPs and clinicians/researchers agreed with all definitions and descriptions with agreements ranging from 87% to 100%. Respondents suggested wording changes to the names, definitions and descriptions to better reflect the domains. Discussions led to further simplification and clarification to address common questions/concerns about the domains. CONCLUSION Our WG reached consensus on the definitions and descriptions of the domains of the core domain set for rheumatology trials of SDM interventions. This step is crucial to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE The current study provides consensus-based definitions and descriptions for the domains of the OMERACT core domain set for shared decision making interventions from patients/caregivers, clinicians and researchers. This is a crucial step to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set for trials of SDM interventions.
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Affiliation(s)
- Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia; Arthritis Research Canada, Canada
| | - Peter Brooks
- School of Population and Global Health, University of Melbourne and Northern Health, Melbourne, Australia
| | - Dawn Stacey
- School of Nursing, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, University Health Network, Canada
| | | | - Marieke Voshaar
- Patient Research Partner; Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tanya Meade
- Western Sydney University, Sydney, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital; The University of Sydney, Australia
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington. Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Yasser El-Miedany
- Canterbury Christ Church University, Canterbury; King's College London, London, United Kingdom
| | - Shikha Mittoo
- Vanshavardhana Canada Integrated Health, Toronto, Canada
| | - Tiffany Westrich Robertson
- CEO, Patient research partner, International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis), USA
| | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University; Research Institute, McGill University Health Centre; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | | | - Melissa Mannion
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anne Boel
- Department of Rheumatology, Leiden University Medical Centre; UCB Pharma, B.V. Netherlands, Leiden, the Netherlands
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom
| | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, Strasbourg, France
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Ellen Moholt
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway
| | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain, Spain
| | | | - Ajesh Maharaj
- Department of Internal Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Beverly Shea
- Bruyère Research Institute; Ottawa Hospital Research Institute; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Christopher Fong
- Eastern Clinical Research Unit, Monash University, Melbourne, Australia
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London; Rheumatology Department, King's College Hospital, London, United Kingdom
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Regina Greer-Smith
- Patient Research Partner, President/CEO, Healthcare Research Associates, LLC/S.T.A.R. Initiative; Ambassador, Patient-Centered Outcomes Research Institute, Apple Valley, CA, USA
| | - Victor S Sloan
- Sheng Consulting LLC, Flemington, New Jersey USA; The Peace Corps, Washington, DC, USA
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Valerie Umaefulam
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Nouran Abaza
- Professor of Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Simon Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Laure Gossec
- Professor of Rheumatology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, the Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Denmark
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, University of Montreal; Researcher Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada; Sainte-Justine University Health Center Research Center, Montreal, Canada
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital; GW School of Medicine, Washington, DC, USA
| | - Deb Constien
- Patient Research Partner, Central Regional Lead, Advocacy Leadership Board Chair, International Foundation of Autoimmune Autoinflammatory Arthritis (AiArthritis), Madison, Wisconsin, USA
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa; Department of Pediatrics, Faculty of Medicine, University of Ottawa; Affiliate scientist, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada.
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Naye F, Toupin-April K, de Wit M, LeBlanc A, Dubois O, Boonen A, Barton JL, Fraenkel L, Li LC, Stacey D, March L, Barber CEH, Hazlewood GS, Guillemin F, Bartlett SJ, Berthelsen DB, Mather K, Arnaud L, Akpabio A, Adebajo A, Schultz G, Sloan VS, Gill TK, Sharma S, Scholte-Voshaar M, Caso F, Nikiphorou E, Nasef SI, Campbell W, Meara A, Christensen R, Suarez-Almazor ME, Jull JE, Alten R, Morgan EM, El-Miedany Y, Singh JA, Burt J, Jayatilleke A, Hmamouchi I, Blanco FJ, Fernandez AP, Mackie S, Jones A, Strand V, Monti S, Stones SR, Lee RR, Nielsen SM, Evans V, Srinivasalu H, Gérard T, Demers JL, Bouchard R, Stefan T, Dugas M, Bergeron F, Beaton D, Maxwell LJ, Tugwell P, Décary S. OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments. Semin Arthritis Rheum 2024; 65:152344. [PMID: 38232625 DOI: 10.1016/j.semarthrit.2023.152344] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada; VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Olivia Dubois
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lyn March
- Department of Medicine, The University of Sydney, Sydney, Australia; Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Canada; Research Institute - McGill University Health Centre, Canada; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, Odense & Department of Rehabilitation, Municipality of Guldborgsund, Odense University Hospital, University of Southern Denmark, Nykoebing, Denmark
| | | | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, France
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | | | - Victor S Sloan
- Sheng Consulting LLC, Flemington, NJ, USA; The Peace Corps, Washington, DC, USA
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Marieke Scholte-Voshaar
- Patient Research Partner, Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Willemina Campbell
- Patient research partner, Toronto Western Hospital, University Health Network, Canada
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Denmark
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Simon R Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Demark, Copenhagen, Denmark
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital, Washington DC, USA; GW School of Medicine, Washington DC, USA
| | - Thomas Gérard
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | | | - Roxanne Bouchard
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Théo Stefan
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Michèle Dugas
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | | | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Iziduh S, Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall DA, Gagliardi AR. Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey. BMJ Open 2024; 14:e080301. [PMID: 38373862 PMCID: PMC10897840 DOI: 10.1136/bmjopen-2023-080301] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Osteoarthritis (OA) prevalence, severity and related comorbid conditions are greater among women compared with men, but women, particularly racialised women, are less likely than men to access OA care. We aimed to prioritise strategies needed to reduce inequities in OA management. DESIGN Delphi survey of 28 strategies derived from primary research retained if at least 80% of respondents rated 6 or 7 on a 7-point Likert scale. SETTING Online. PARTICIPANTS 35 women of diverse ethno-cultural groups and 29 healthcare professionals of various specialties from across Canada. RESULTS Of the 28 initial and 3 newly suggested strategies, 27 achieved consensus to retain: 20 in round 1 and 7 in round 2. Respondents retained 7 patient-level, 7 clinician-level and 13 system-level strategies. Women and professionals agreed on all but one patient-level strategy (eg, consider patients' cultural needs and economic circumstances) and all clinician-level strategies (eg, inquire about OA management needs and preferences). Some discrepancies emerged for system-level strategies that were more highly rated by women (eg, implement OA-specific clinics). Comments revealed general support among professionals for system-level strategies provided that additional funding or expanded scope of practice was targeted to only formally trained professionals and did not reduce funding for professionals who already managed OA. CONCLUSIONS We identified multilevel strategies that could be implemented by healthcare professionals, organisations or systems to mitigate inequities and improve OA care for diverse women.
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Affiliation(s)
- Sharon Iziduh
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Angela Abenoja
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vandana Ahluwalia
- William Osler Health System - Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Marisa Battistella
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah A Marshall
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Gagliardi AR, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V. Multi-level strategies to improve equitable timely person-centred osteoarthritis care for diverse women: qualitative interviews with women and healthcare professionals. Int J Equity Health 2023; 22:207. [PMID: 37803475 PMCID: PMC10559457 DOI: 10.1186/s12939-023-02026-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. METHODS We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. RESULTS We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. CONCLUSIONS This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Deborah Marshall
- University of Calgary, 2500 University Drive NW, Calgary Alberta T2N1N4, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, 82 Buttonwood Ave, York, M6M2J5, Canada
| | - Cornelia M Borkhoff
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Aisha Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Abuwa C, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines. BMC Musculoskelet Disord 2023; 24:734. [PMID: 37710195 PMCID: PMC10500823 DOI: 10.1186/s12891-023-06877-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. METHODS We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. RESULTS We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. CONCLUSIONS This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. PATIENT OR PUBLIC CONTRIBUTION This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
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Affiliation(s)
- Chidinma Abuwa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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Abenoja A, Theodorlis M, Ahluwalia V, Battistella M, Borkhoff CM, Hazlewood GS, Lofters A, MacKay C, Marshall D, Gagliardi AR. Strategies to Improve Equitable Access to Early Osteoarthritis Diagnosis and Management: An updated Review. Arthritis Care Res (Hoboken) 2023. [PMID: 37382031 DOI: 10.1002/acr.25179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Though osteoarthritis (OA) affects millions of people worldwide, many fail to access recommended early, person-centered OA care, particularly women who are disproportionately impacted by OA. A prior review identified few strategies to improve equitable access to early diagnosis and management for multiple disadvantaged groups. We aimed to update that review with literature published in 2010 or later on strategies to improve OA care for disadvantaged groups including women. We identified only 11 eligible studies, of which only 2 (18%) focused on women only. Other disadvantaged groups targeted in the largely US-based studies included patients who are Black, Spanish-speaking, rural, and adults aged 60 years and older. All studies evaluated interventions targeted to patients; 4 (36%) assessed video decision aids, and 7 (63.6%) assessed in-person, video, or telephone self-management education. Interventions were often multifaceted (n = 9, 82%), and most studies (n = 8, 73%) achieved positive outcomes in at least some outcomes measured. No studies evaluated clinician- or system-level strategies. Few studies (n = 5, 45%) described how they tailored strategies to disadvantaged groups or how they addressed person-centered care concepts apart from enabling self-management. Future research is needed to develop, implement, evaluate, and scale-up multilevel strategies to enhance equitable, person-centered OA care for disadvantaged groups including women.
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Affiliation(s)
- Angela Abenoja
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther 2017; 45:3-13. [PMID: 27862107 DOI: 10.1111/apt.13847] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/26/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) have a progressive course leading to hospitalisation and surgery. The ability of existing therapies to alter disease course is not clearly defined. AIM To investigate the comparative efficacy of currently available inflammatory bowel disease (IBD) therapies to reduce hospitalisation and surgery. METHODS We conducted a systematic review in MEDLINE/PubMed for randomised controlled trials (RCT) published between January 1980 and May 2016 examining efficacy of biological or immunomodulator therapy in IBD. We performed direct comparisons of pooled proportions of hospitalisation and surgery. Pair-wise comparisons using a random-effects Bayesian network meta-analysis were performed to assess comparative efficacy of different treatments. RESULTS We identified seven randomised controlled trials (5 CD; 2 UC) comparing three biologics and one immunomodulator with placebo. In CD, anti-TNF biologics significantly reduced hospitalisation [Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.36-0.60] and surgery (OR 0.23, 95% CI 0.13-0.42) compared to placebo. No statistically significant reduction was noted with azathioprine or vedolizumab. Azathioprine was inferior to both infliximab and adalimumab in preventing CD-related hospitalisation (>97.5% probability). Anti-TNF biologics significantly reduced hospitalisation (OR 0.48, 95% CI 0.29-0.80) and surgery (OR 0.67, 95% CI 0.46-0.97) in UC. There were no statistically significant differences in the pair-wise comparisons between active treatments. CONCLUSIONS In CD and UC, anti-TNF biologics are efficacious in reducing the odds of hospitalisation by half and surgery by 33-77%. Azathioprine and vedolizumab were not associated with a similar improvement, but robust conclusions may be limited due to paucity of RCTs.
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Affiliation(s)
- E J Mao
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - G S Hazlewood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre, France
| | - A N Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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