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Munce SEP, Wong E, Luong D, Rao J, Cunningham J, Bailey K, John T, Barber C, Batthish M, Chambers K, Cleverley K, Crabtree M, Diaz S, Dimitropoulos G, Gorter JW, Grahovac D, Grimes R, Guttman B, Hébert ML, Henze M, Higgins A, Khodyakov D, Li E, Lo L, Macgregor L, Mooney S, Severino SM, Mukerji G, Penner M, Pidduck J, Shulman R, Stromquist L, Trbovich P, Wan M, Williams L, Yates D, Toulany A. Patient, caregiver and other knowledge user engagement in consensus-building healthcare initiatives: a scoping review protocol. BMJ Open 2024; 14:e080822. [PMID: 38719333 PMCID: PMC11086512 DOI: 10.1136/bmjopen-2023-080822] [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: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Patient engagement and integrated knowledge translation (iKT) processes improve health outcomes and care experiences through meaningful partnerships in consensus-building initiatives and research. Consensus-building is essential for engaging a diverse group of experienced knowledge users in co-developing and supporting a solution where none readily exists or is less optimal. Patients and caregivers provide invaluable insights for building consensus in decision-making around healthcare, policy and research. However, despite emerging evidence, patient engagement remains sparse within consensus-building initiatives. Specifically, our research has identified a lack of opportunity for youth living with chronic health conditions and their caregivers to participate in developing consensus on indicators/benchmarks for transition into adult care. To bridge this gap and inform our consensus-building approach with youth/caregivers, this scoping review will synthesise the extent of the literature on patient and other knowledge user engagement in consensus-building healthcare initiatives. METHODS AND ANALYSIS Following the scoping review methodology from Joanna Briggs Institute, published literature will be searched in MEDLINE, EMBASE, CINAHL and PsycINFO databases from inception to July 2023. Grey literature will be hand-searched. Two independent reviewers will determine the eligibility of articles in a two-stage process, with disagreements resolved by a third reviewer. Included studies must be consensus-building studies within the healthcare context that involve patient engagement strategies. Data from eligible studies will be extracted and charted on a standardised form. Abstracted data will be analysed quantitatively and descriptively, according to specific consensus methodologies, and patient engagement models and/or strategies. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. Dissemination of findings will also include peer-reviewed publications and conference presentations. The results will offer new insights for supporting patient engagement in consensus-building healthcare initiatives. PROTOCOL REGISTRATION https://osf.io/beqjr.
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Affiliation(s)
- Sarah E P Munce
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elliott Wong
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dorothy Luong
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Justin Rao
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Bailey
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Tomisin John
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Barber
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Kyle Chambers
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health Queen Street Site, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Crabtree
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Sanober Diaz
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Southern Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Danijela Grahovac
- National Health Hub in Transition, Children's Healthcare Canada, Hamilton, Southern Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Southern Ontario, Canada
| | - Ruth Grimes
- Canadian Pediatric Society, Winnipeg, Manitoba, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Michèle L Hébert
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Henze
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Surrey Place Centre, Toronto, Ontario, Canada
| | - Amanda Higgins
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Elaine Li
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Lisha Lo
- University of Toronto Centre for Quality Improvement and Patient Safety, Toronto, Ontario, Canada
| | - Laura Macgregor
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Martin Luther University College, Waterloo, Ontario, Canada
| | - Sarah Mooney
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Samadhi Mora Severino
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Melanie Penner
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jacklynn Pidduck
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Rayzel Shulman
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Endocrinology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Stromquist
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- National Health Hub in Transition, Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - Patricia Trbovich
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Patient Safety and Quality Improvement, North York General Hospital, Toronto, Ontario, Canada
| | - Michelle Wan
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Laura Williams
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Darryl Yates
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Alene Toulany
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Cassidy CE, Kontak JC, Pidduck J, Higgins A, Anderson S, Best S, Grant A, Jeffers E, MacDonald S, MacKinnon L, Mireault A, Rowe L, Walls R, Curran J. Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour. Journal of Transition Medicine 2022. [DOI: 10.1515/jtm-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.
Methods
A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.
Results
In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.
Conclusions
By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.
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Affiliation(s)
- Christine E. Cassidy
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| | - Julia C. Kontak
- Maritime SPOR SUPPORT Unit, Nova Scotia Health and Faculty of Health, Dalhousie University , Halifax , NS , Canada
| | | | | | - Scott Anderson
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | - Amy Grant
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Elizabeth Jeffers
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | | | - Amy Mireault
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Liam Rowe
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Rose Walls
- Mental Health and Addictions, Nova Scotia Health , Halifax , NS , Canada
| | - Janet Curran
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
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