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Ndjaboue R, Beaudoin C, Comeau S, Dagnault A, Dogba MJ, Numainville S, Racine C, Straus S, Tremblay MC, Witteman HO. Patients as teachers: a within-subjects randomized pilot experiment of patient-led online learning modules for health professionals. BMC Med Educ 2024; 24:525. [PMID: 38730313 DOI: 10.1186/s12909-024-05473-4] [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: 10/20/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE Many health professions education programs involve people with lived experience as expert speakers. Such presentations may help learners better understand the realities of living with chronic illness or experiencing an acute health problem. However, lectures from only one or a small number of people may not adequately illustrate the perspectives and experiences of a diverse patient cohort. Additionally, logistical constraints such as public health restrictions or travel barriers may impede in-person presentations, particularly among people who have more restrictions on their time. Health professions education programs may benefit from understanding the potential effects of online patient-led presentations with a diverse set of speakers. We aimed to explore whether patient-led online learning modules about diabetes care would influence learners' responses to clinical scenarios and to collect learners' feedback about the modules. METHOD This within-subjects randomized experiment involved 26 third-year medical students at Université Laval in Quebec, Canada. Participation in the experiment was an optional component within a required course. Prior to the intervention, participating learners responded to three clinical scenarios randomly selected from a set of six such scenarios. Each participant responded to the other three scenarios after the intervention. The intervention consisted of patient-led online learning modules incorporating segments of narratives from 21 patient partners (11 racialized or Indigenous) describing why and how clinicians could provide patient-centered care. Working with clinical teachers and psychometric experts, we developed a scoring grid based on the biopsychosocial model and set 0.6 as a passing score. Independent evaluators, blinded to whether each response was collected before or after the intervention, then scored learners' responses to scenarios using the grid. We used Fisher's Exact test to compare proportions of passing scores before and after the intervention. RESULTS Learners' overall percentage of passing scores prior to the intervention was 66%. Following the intervention, the percentage of passing scores was 76% (p = 0.002). Overall, learners expressed appreciation and other positive feedback regarding the patient-led online learning modules. DISCUSSION Findings from this experiment suggest that learners can learn to provide better patient-centered care by watching patient-led online learning modules created in collaboration with a diversity of patient partners.
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Etenaille M, Lecocq D, Herpelinck P, Parent F, Foucart J. Evaluation of inter-professional seminar involving patient-partners and caregivers. Patient Educ Couns 2023; 115:107902. [PMID: 37499448 DOI: 10.1016/j.pec.2023.107902] [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: 01/31/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To assess the contribution of interprofessional education (IPE) for pre-graduate students from eight study branches. These seminars had patient-partners and caregivers as co-facilitators for reflexive conversations, with educational goals of learning interprofessional communication and involving patients in decision-making. METHODS A pre/post seminar comparison with 2 questionnaires about the students' professional identity, multidisciplinary collaboration and patients' involvement, and the richness of stakeholders' definitions. RESULTS 1142 students participated in the course (n = 740 after removing missing data). The results indicate that this type of education helps students feel more confident in their ability to communicate and collaborate (z = -10,204; p < 0,001), involves patients in their care plan (z = -7,996; p < 0,001) and fosters the competence and autonomy of the post-graduate students in their own professional field (z = -10,627; p < 0,001). It also enriches the definition of patients' roles (n = 399; z = -17,276; p < 0,001). CONCLUSION Including patients-partners and caregivers in IPE enriches the professional identity and increases the self-efficacy of futures caregivers. PRACTICE IMPLICATIONS This program exposed students to collaborative care practices, can reduce their resistance to this type of practice after graduation by making them more confident in using a structured team approach and recognising its benefits for both patients and caregivers.
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Affiliation(s)
- Maxime Etenaille
- Research Unit in Sciences of Osteopathy, Faculty of Motor Sciences, Université libre de Bruxelles, Brussels, Belgium; Research Unit in Motor Psychophysiology, Faculty of Motor Sciences, Université libre de Bruxelles, Brussels, Belgium
| | - Dan Lecocq
- Center for Research in Health Economics, Management of Health Care Institutions and Nursing, School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Nursing Section, Health Department, Haute École Libre de Bruxelles Ilya Prigogine, Brussels, Belgium; Education Department, School of Public Health, Université libre de Bruxelles, Bruxelles, Belgium
| | - Pascaline Herpelinck
- Nursing Section, Health Department, Haute École Libre de Bruxelles Ilya Prigogine, Brussels, Belgium; Education Department, School of Public Health, Université libre de Bruxelles, Bruxelles, Belgium
| | - Françoise Parent
- Healthcare Division, Université libre de Bruxelles, Brussels, Belgium
| | - Jennifer Foucart
- Research Unit in Motor Psychophysiology, Faculty of Motor Sciences, Université libre de Bruxelles, Brussels, Belgium.
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Savas S, Etchegary H, Stuckless T, Whitten C, Wiseman J, Bishop D, King J, Cutting J, Peddle D. Public Interest Group on Cancer Research: a successful patient-researcher partnership in Newfoundland and Labrador. Res Involv Engagem 2022; 8:46. [PMID: 36057599 PMCID: PMC9440646 DOI: 10.1186/s40900-022-00380-8] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Partnering with patients and family members affected by cancer is essential for meaningful research, public engagement and outreach, and advocacy activities. OBJECTIVE Our objective was to create a public interest group through an academic-community partnership focused on cancer research and public engagement. METHODS A purposeful recruitment process was implemented to ensure a diverse and inclusive group. The group meets virtually and communicates by email. The group's activities focus on identifying the needs, priorities, and interests of cancer-affected individuals in the province; consultations; and designing research projects and public outreach activities together. Comprehensive meeting minutes are kept and used to distill discussion points. The work of the group is disseminated through a variety of channels. RESULTS The public interest group includes 12 cancer patient and family member representatives, in addition to researchers. Discussions by the interest group identified key themes related to: (1) equity issues and regional disparity in provincial oncocare; (2) information needs; (3) need for patient empowerment and public understanding; and (4) family member and partner needs and experiences. To date, the group has co-designed a cancer research proposal and a public engagement/outreach activity. The group also provides consultations on cancer-related projects/public engagement activities and members act as patient partners in specific research and public engagement proposals. The group evolves over time, and increasingly advocates on behalf of cancer patients and families. Retention and satisfaction of the public partners with group activities have been high. The group's work and findings are disseminated to the Provincial Cancer Care Program, as well as to public and scientific stakeholders through local media, academic conferences and presentations, and a dedicated website. CONCLUSION Public Interest Group on Cancer Research represents a highly successful patient-researcher partnership in oncology. It designs meaningful and patient-oriented studies and outreach activities in cancer. It also elevates and widely supports cancer patient and family voice.
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Affiliation(s)
- Sevtap Savas
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, Room 5M324, St. John's, NL, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
- Public Interest Group on Cancer Research, St. John's, NL, Canada.
| | - Holly Etchegary
- Public Interest Group on Cancer Research, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
- NLSUPPORT, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Teri Stuckless
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada
- Public Interest Group on Cancer Research, St. John's, NL, Canada
- Provincial Cancer Care Program, Eastern Health, St. John's, NL, Canada
| | - Cindy Whitten
- Public Interest Group on Cancer Research, St. John's, NL, Canada
- Research and Innovation, Eastern Health, St. John's, NL, Canada
| | - Jason Wiseman
- Public Interest Group on Cancer Research, St. John's, NL, Canada
| | - Derrick Bishop
- Public Interest Group on Cancer Research, St. John's, NL, Canada
| | - John King
- Public Interest Group on Cancer Research, St. John's, NL, Canada
| | - Janine Cutting
- Public Interest Group on Cancer Research, St. John's, NL, Canada
| | - Darrell Peddle
- Public Interest Group on Cancer Research, St. John's, NL, Canada
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Pougheon Bertrand D, Fanchini A, Lombrail P, Rault G, Chansard A, Le Breton N, Frenod C, Milon F, Heymes-Royer C, Segretain D, Silber M, Therouanne S, Haesebaert J, Llerena C, Michel P, Reynaud Q. Collaborative research protocol to define patient-reported experience measures of the cystic fibrosis care pathway in France: the ExPaParM study. Orphanet J Rare Dis 2022; 17:73. [PMID: 35193621 PMCID: PMC8861995 DOI: 10.1186/s13023-022-02204-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/06/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction In France, the cystic fibrosis (CF) care pathway is coordinated by multidisciplinary teams from specialised CF centres or transplant centres. It includes the care provided at home or out of hospital, risk prevention in daily life and adjustments to social life, which together contribute to the person’s quality of life. Patient experience is used to describe and evaluate the care and life of patients living with the disease. Objectives Our collaborative research aims to identify the most significant areas and criteria that characterise the CF pathway. It will lead to the development of a questionnaire to collect patients' experience, which can be administered to all patients or parents of children registered and followed in the centres. The article describes the protocol developed in partnership with patients and parents of children living with the disease. Method A multidisciplinary research group brings together researchers, patients, parents of children with CF and health care professionals. The patient partnership is involved in the 4 phases of the protocol: (1) setting up the study, recruiting patient and parent co-researchers, training them in qualitative research methods, defining the situations and profiles of patients in the study population, elaborating the protocol; (2) selecting the study sites, recruiting participants, carrying out semi-structured interviews, analysing verbatims using the grounded theory approach; (3) co-elaborating Patient-Reported Experience Measures (PREM) questionnaires adapted to the 4 types of participants: parents, adolescents, non-transplanted adults and transplanted adults; (4) validating the construct with participants and professionals from the study centres. Results The protocol obtained a favourable opinion from the Ethics Evaluation Committee of INSERM (IRB00003888—no. 20-700). Training was provided to the 5 patients and 2 parent co-researchers to enable them to participate effectively in the research. Eleven centres participated in the recruitment of participants in mainland France and Reunion Island. Eighty hours of interviews were conducted. Discussion The PREM questionnaires to be elaborated will have to undergo psychometric validation before being used by the actors of the CF network to assess the impact on the care pathways of quality approaches or new therapies available in cystic fibrosis. Trial Registration Registry: IRB00003888 – no. 20-700. Issue date: 06/09/2020.
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Affiliation(s)
- D Pougheon Bertrand
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France.
| | - A Fanchini
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - P Lombrail
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - G Rault
- Laboratory of Education and Health Practices (LEPS) UR3412, Sorbonne Paris Nord University, Villetaneuse, France
| | - A Chansard
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - N Le Breton
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - C Frenod
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - F Milon
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - C Heymes-Royer
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - D Segretain
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - M Silber
- Cystic Fibrosis Patient and Parent Co-Investigators Group, Paris, France
| | - S Therouanne
- Centre de Ressources et de Compétences mucoviscidose, CHU Lille, Lille, France
| | - J Haesebaert
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - C Llerena
- Centre de Ressources et de Compétences mucoviscidose, Hôpital Couple-Enfants, Grenoble, France
| | - P Michel
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France.,Quality and Security Department, Hospices Civils de Lyon, Lyon, France
| | - Q Reynaud
- Laboratory RESHAPE U. INSERM 1290, Claude Bernard Lyon 1 University, Villeurbanne, France.,Centre de Ressources et de Compétences mucoviscidose, Hôpital Lyon Sud, Pierre-Bénite, France
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Bourmaud A, Piot de Villars E, Renault-Teissier E. [ Patient partnership and patient education in oncology]. Bull Cancer 2021; 109:588-597. [PMID: 34782118 DOI: 10.1016/j.bulcan.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 40years, the French health system has opened up to patient engagement. Society has recognised the legitimacy of the patient as a decision-maker in his or her own health and as an expert in his or her illness. This is true at the individual level in the context of doctor-patient relationship, and at the organisational level within institutions, in decision-making or academic groups. The aim of this study is to present the concepts of patient-partnership, patient education and to illustrate the different functions that patient-partners can take within the organisation of patient education programmes, and in the field of oncology. METHOD A narrative review of the literature was carried out to extract relevant and recent seminal articles to address these points. RESULTS The Montreal model establishes the patient partner as a full care actor. He can thus contribute his expertise in many fields of application: care, research or teaching. The aim of patient education is to empower the patient in the management of his or her disease, treatment and the consequences of these on daily life. The patient partner has a full place in this system where he can accompany his peers, but also collaborate with the educational team to develop new programmes, evaluate them and even conduct research. The implementation of these systems consists of getting individuals with different cultures and operating methods to work together. It is a process that requires time, effort and attention to each other.
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Affiliation(s)
- Aurelie Bourmaud
- Universitary hospital Robert-Debré, université de Paris, Clinical epidemiology unit, Inserm ECEVE, 1123 Paris, France.
| | | | - Evelyne Renault-Teissier
- Pain unit, DISSPO, douleur et soins palliatifs, universitary comprehensive cancer institut, Institut Curie, Paris, France
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Pomey MP, de Guise M, Desforges M, Bouchard K, Vialaron C, Normandin L, Iliescu-Nelea M, Fortin I, Ganache I, Régis C, Rosberger Z, Charpentier D, Bélanger L, Dorval M, Ghadiri DP, Lavoie-Tremblay M, Boivin A, Pelletier JF, Fernandez N, Danino AM. The patient advisor, an organizational resource as a lever for an enhanced oncology patient experience (PAROLE-onco): a longitudinal multiple case study protocol. BMC Health Serv Res 2021; 21:10. [PMID: 33397386 PMCID: PMC7780212 DOI: 10.1186/s12913-020-06009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/09/2020] [Accepted: 12/09/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Quebec is one of the Canadian provinces with the highest rates of cancer incidence and prevalence. A study by the Rossy Cancer Network (RCN) of McGill university assessed six aspects of the patient experience among cancer patients and found that emotional support is the aspect most lacking. To improve this support, trained patient advisors (PAs) can be included as full-fledged members of the healthcare team, given that PA can rely on their knowledge with experiencing the disease and from using health and social care services to accompany cancer patients, they could help to round out the health and social care services offer in oncology. However, the feasibility of integrating PAs in clinical oncology teams has not been studied. In this multisite study, we will explore how to integrate PAs in clinical oncology teams and, under what conditions this can be successfully done. We aim to better understand effects of this PA intervention on patients, on the PAs themselves, the health and social care team, the administrators, and on the organization of services and to identify associated ethical and legal issues. METHODS/DESIGN We will conduct six mixed methods longitudinal case studies. Qualitative data will be used to study the integration of the PAs into clinical oncology teams and to identify the factors that are facilitators and inhibitors of the process, the associated ethical and legal issues, and the challenges that the PAs experience. Quantitative data will be used to assess effects on patients, PAs and team members, if any, of the PA intervention. The results will be used to support oncology programs in the integration of PAs into their healthcare teams and to design a future randomized pragmatic trial to evaluate the impact of PAs as full-fledged members of clinical oncology teams on cancer patients' experience of emotional support throughout their care trajectory. DISCUSSION This study will be the first to integrate PAs as full-fledged members of the clinical oncology team and to assess possible clinical and organizational level effects. Given the unique role of PAs, this study will complement the body of research on peer support and patient navigation. An additional innovative aspect of this study will be consideration of the ethical and legal issues at stake and how to address them in the health care organizations.
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Affiliation(s)
- M P Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.
- Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada.
- École de santé publique de l'université de Montréal-Département de gestion, évaluation et politique de santé, 7101 Av du Parc, Montréal, Québec, H3N 1X9, Canada.
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada.
| | - M de Guise
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - M Desforges
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - K Bouchard
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - C Vialaron
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - L Normandin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - M Iliescu-Nelea
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - I Fortin
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - I Ganache
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - C Régis
- Université de Montréal - Faculté de Droit, 3101 chemin de la Tour, Montréal, Québec, H3T 1J7, Canada
| | - Z Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & McGill University, Gerald Bronfman Department of Oncology, 5100 de Maisonneuve Blvd West, Montréal, Québec, H4A 3T2, Canada
| | - D Charpentier
- Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
| | - L Bélanger
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - M Dorval
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
- Université Laval - Faculté de pharmacie, 050, avenue de la Médecine, Québec, Québec, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 chemin Sainte-Foy, Québec, Québec, G1S4L8, Canada
- Centre de recherche du CISSS Chaudière Appalaches, 143 rue Wolfe, Lévis, Québec, G6V 3Z1, Canada
| | - D P Ghadiri
- HEC Montréal, Department of management, 3000, chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | - M Lavoie-Tremblay
- McGill University, Ingram School of Nursing (IsoN), 680 Sherbrooke Street West, Montreal, Québec, H3A 2M7, Canada
- Centre Universitaire de Santé McGill (CUSM), 1650, avenue Cedar, Montréal, Québec, H3G 1A4, Canada
| | - A Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
- Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - J F Pelletier
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
- Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, 7331 Rue Hochelaga, Montréal, Québec, H1N 3V2, Canada
| | - N Fernandez
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - A M Danino
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
- Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
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Haaser T, Constantinidès Y, Dejean C, Escande A, Le Tallec P, Lorchel F, Marty S, Thureau S, Huguet F, Lagrange JL. [Health democracy: Patient partnership]. Cancer Radiother 2020; 24:736-743. [PMID: 32861610 DOI: 10.1016/j.canrad.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/20/2022]
Abstract
In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership. Indeed, the writing of the White Book of Cancer gave voice to sick people and stressed the need for new devices, such as the Caregiving Time. Patients can no longer be considered as objects of care but as people whose dignity and autonomy must be imperatively respected. The acquisition of knowledge allows a bilateral exchange, prerequisite of a dynamic collaboration. Patients can be partners in their own care, partners in training and research (expert patient), but also partners in health institutions and policies. It is this notion of partnership and involvement of the person in their path of care in radiation oncology that we will analyse here. It will be about defining it, by developing the concept of autonomy, and bringing out its complexity and ambivalence through two examples from our clinical practice: the shared decision-making process for patients with localized prostate cancer and the patient's involvement in the success of his radiotherapy.
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Affiliation(s)
- T Haaser
- Service de radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, Pessac, France.
| | - Y Constantinidès
- Espace éthique Île-de-France, Paris Université Sorbonne Nouvelle, Paris, France
| | - C Dejean
- Service de radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire de radiothérapie, laboratoire CRIStAL, UMR9189, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, université de Lille, Lille, France
| | - P Le Tallec
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Lorchel
- Centre de radiothérapie et oncologie de Mâcon - Orlam, Mâcon, France; Service de radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France
| | - S Marty
- Centre de coordination en cancérologie, centre hospitalier universitaire de Bordeaux, Pessac, France
| | - S Thureau
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Huguet
- Service d'oncologie radiothérapie, centre de recherche Saint-Antoine UMR_S 938, Sorbonne université, hôpital Tenon, institut universitaire de cancérologie, AP-HP, Paris, France
| | - J-L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
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Martineau JT, Minyaoui A, Boivin A. Partnering with patients in healthcare research: a scoping review of ethical issues, challenges, and recommendations for practice. BMC Med Ethics 2020; 21:34. [PMID: 32393230 PMCID: PMC7216517 DOI: 10.1186/s12910-020-0460-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 07/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partnering with patients in healthcare research now benefits from a strong rationale and is encouraged by funding agencies and research institutions. However, this new approach raises ethical issues for patients, researchers, research professionals and administrators. The main objective of this review is to map the literature related to the ethical issues associated with patient partnership in healthcare research, as well as the recommendations to address them. Our global aim is to help researchers, patients, research institutions and research ethics boards reflecting on and dealing with these issues. METHODS We conducted a scoping review of the ethical issues and recommendations associated with partnering with patients in healthcare research. After our search strategy, 31 peer reviewed articles published between 2007 and 2017 remained and were analyzed. RESULTS We have identified 58 first-order ethical issues and challenges associated with patient partnership in research, regrouped in 18 second-order ethical themes. Most of the issues are transversal to all phases and stages of the research process and a lot of them could also apply to patient-partnership in other spheres of health, such as governance, quality improvement, and education. We suggested that ethical issues and challenges of partnered research can be related to four ethical frameworks: 1) Research ethics; 2) Research integrity; 3) Organizational ethics, and 4) Relational ethics. CONCLUSIONS We have identified numerous ethical issues associated with the recent approach of patient-partnership in research. These issues are more diverse than the issues associated with a more traditional research approach. Indeed, the current discussion on how we address ethical issues in research is anchored in the assumption that patients, as research participants, must be protected from risk. However, doing research with, and not on, the patient involves changes in the way we reflect on the ethical issues associated with this approach to research. We propose to broaden the ethical discussion on partnered research to not only rely on a research ethics framework, but to also frame it within the areas of research integrity, organizational ethics and relational ethics.
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Affiliation(s)
- Joé T Martineau
- Department of Management, HEC Montreal, 3000 chemin de la Cote-Ste-Catherine, Montreal, QC, H3T2A7, Canada.
| | | | - Antoine Boivin
- Canada Research Chair in Patient and Public Partnership, CHUM Research Center (CRCHUM) and University of Montreal, Montreal, Canada
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Clavel N, Pomey MP, Ghadiri DPS. Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers? BMC Health Serv Res 2019; 19:815. [PMID: 31703678 PMCID: PMC6839263 DOI: 10.1186/s12913-019-4618-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/15/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023] Open
Abstract
Background Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. Methods In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. Results Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. Conclusion This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.
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Affiliation(s)
- Nathalie Clavel
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, Canada.
| | - Marie-Pascale Pomey
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, Canada
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Rice R, Nuzum D, O’Connell O, O’Donoghue K. Parents and clinicians: partners in perinatal bereavement research -experiences from the International Stillbirth Alliance Conference 2017. Res Involv Engagem 2019; 5:4. [PMID: 30774980 PMCID: PMC6357380 DOI: 10.1186/s40900-018-0137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
In recent years, there has been a global call to reduce the numbers of preventable stillbirths and increase public awareness about the incidence and impact of pregnancy loss. The lived experiences of bereaved parents have much to contribute to developing the research agenda and clinical care in pregnancy loss. The multidisciplinary Pregnancy Loss Research Group (PLRG) based at the INFANT Centre at University College Cork and Cork University Maternity Hospital, has an established practice of active engagement and participation of patient members. This partnership provided the catalyst to model a similar collaborative approach between clinicians, researchers and bereaved parents when the PLRG was successful in their bid to host the International Stillbirth Alliance (ISA) annual conference in 2017. Over 400 hundred delegates from around the globe attended the conference, of which one quarter were bereaved parents. Establishing a culture of collaboration, support and mutual respect in the field of pregnancy loss, requires scientists, clinicians and parents to be brought together so each can be informed by the other in the efforts to prevent stillbirth and improve bereavement care. As part of ISA 2017 conference, a sub-committee of staff and parents was established to ensure that the voice of parents could contribute to the research agenda and developments in clinical and bereavement care. A creative workshop specifically for parents, followed by a parent assembly were organised to facilitate this. Remembrance activities, organised by the parent committee, were central to the conference and actively engaged in by parents, clinicians and researchers. This commentary, written collaboratively by a parent, a chaplain, a bereavement and loss specialist midwife and a consultant obstetrician, gives voice to this experience, identifying four key messages that arose from our reflection on the conference. These include; the value of active partnership between clinicians and patients, the use of creativity as a unifying expression of grief and as a means to facilitate learning, the value of collaboration with global stakeholders in raising awareness about stillbirth, and the importance of facilitating meaningful patient/public engagement in scientific research. The potential for education and learning opportunities are also explored, highlighting the connection between parents, researchers and clinicians as central stakeholders in the prevention of stillbirth and in improving bereavement care.
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Affiliation(s)
- Rachel Rice
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Daniel Nuzum
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Orla O’Connell
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O’Donoghue
- Pregnancy Loss Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Wilton, Cork, Ireland
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Giguere AMC, Lawani MA, Fortier-Brochu É, Carmichael PH, Légaré F, Kröger E, Witteman HO, Voyer P, Caron D, Rodríguez C. Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial. Trials 2018; 19:332. [PMID: 29941020 PMCID: PMC6019313 DOI: 10.1186/s13063-018-2697-1] [Citation(s) in RCA: 15] [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: 11/15/2016] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The increasing prevalence of Alzheimer’s disease and other forms of dementia raises new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Therefore, we aim to evaluate a tailored intervention to help healthcare providers empower seniors and their caregivers in making health-related decisions. Methods In two phases, we will: (1) design and tailor the intervention; and (2) implement and evaluate it. We will use theory and user-centered design to tailor an intervention comprising a distance professional training program on shared decision-making and five shared decision-making tools dealing with difficult decisions often faced by seniors with dementia and their caregivers. Each tool will be designed in two versions, one for clinicians and one for patients. We will recruit 49 clinicians and 27 senior/caregiver to participate in three cycles of design-evaluation-feedback of each intervention components. Besides think-aloud and interview approaches, users will also complete questionnaires based on the Theory of Planned Behavior to identify the factors most likely to influence their adoption of shared decision-making after exposure to the intervention. We will then modify the intervention by adding/enhancing behavior-change techniques targeting these factors. We will evaluate the effectiveness of this tailored intervention before/after implementation, in a two-armed, clustered randomized trial. We will enroll a convenience sample of six primary care clinics (unit of randomization) in the province of Quebec and recruit the clinicians who practice there (mostly family physicians, nurses, and social workers). These clinics will then be randomized to immediate exposure to the intervention or delayed exposure. Overall, we will recruit 180 seniors with dementia, their caregivers, and their healthcare providers. We will evaluate the impact of the intervention on patient involvement in the decision-making process, decisional comfort, patient and caregiver personal empowerment in relation to their own healthcare, patient quality of life, caregiver burden, and decisional regret. Discussion The intervention will empower patients and their caregivers in their healthcare, by fostering their participation as partners during the decision-making process and by ensuring they make informed decisions congruent with their values and priorities. Trial registration ClinicalTrials.org, NCT02956694. Registered on 31 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2697-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anik M C Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada. .,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada. .,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada. .,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.
| | - Moulikatou Adouni Lawani
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Émilie Fortier-Brochu
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Edeltraut Kröger
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.,Faculty of Pharmacy, Laval University, St-Sacrement Hospital, Room L2-30, 1050, Chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Holly O Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada
| | - Philippe Voyer
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Danielle Caron
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Charo Rodríguez
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 chemin de la Cote-des-Neiges, 3rd floor, Suite 300, Room 328, Montreal, Quebec, Canada
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Carman KL, Workman TA. Engaging patients and consumers in research evidence: Applying the conceptual model of patient and family engagement. Patient Educ Couns 2017; 100:25-29. [PMID: 27473639 DOI: 10.1016/j.pec.2016.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This essay discusses applying the Conceptual Framework for Patient and Family Engagement to partnerships with patients and consumers to increase their use of research evidence in healthcare decisions. The framework's foundational principles hold that engagement occurs on a continuum across all levels of healthcare-from direct care to policymaking-with patients and healthcare professionals working in full partnership and sharing responsibility for achieving a safe, high-quality, efficient, and patient-centered healthcare system. DISCUSSION Research evidence can serve as a critical decision-making tool in partnerships between patients and health professionals. However, as the framework suggests, without patient and consumer engagement in the design, planning, interpretation, and dissemination of research findings, it is unlikely that the broader consumer population will find research evidence useful, much less use it, to guide their healthcare decisions. Understanding what factors influence patient and consumer engagement can lead to effective strategies that enable meaningful partnerships between patients and researchers. CONCLUSION Understanding patient and consumer perspectives of research evidence is critical to engaging them in meaningful partnerships that produce actionable research findings that they can in turn use in partnership with health professionals to improve their own health and the healthcare system as a whole.
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Affiliation(s)
- Kristin L Carman
- American Institutes for Research, 1000 Thomas Jefferson Street NW, 20007, Washington DC, United States
| | - Thomas A Workman
- American Institutes for Research, 1000 Thomas Jefferson Street NW, 20007, Washington DC, United States.
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Nortier J, Plennevaux V, Nolf A, Hougardy JM, Petit AD. [Clinical care pathway for chronic kidney disease : development and perspectives]. Rev Med Brux 2017; 38:271-278. [PMID: 28981229] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Because of the significant costs related to the treatment of end-stage kidney disease by dialysis, Belgian Health Care Authorities proposed in June 2009 to launch an early multidisciplinary care plan for chronic kidney disease (CKD) patients in the form of a clinical care pathway (CCP) focusing on a combined follow-up by the general practitioner and the nephrologist. The objective was to increase nephro-protection measures, reduce patient morbidity and mortality, and delay admission on dialysis. Our Nephrology Department at Erasme Hospital took the opportunity of CCP to set up workshops on therapy education which promote CKD patients' compliance and autonomy regarding their treatment (" empowerment "). These workshops are conducted by a health professional together with a patient partner recruited by our team according to the model developed by the faculty of medicine at the University of Montreal. This model is based on the patient's valued experience of living with a chronic disease, a knowledge which is complementary to that acquired by any health professional. This patient partnership (PP) may also be implemented in teaching and research. In health care services, patient partners with a resource profile are involved not only in the organization of these services, but also in the development and management of health care political programs. The PP model currently developed in the Nephrology Department is part of the Quality project of our academic hospital and helps to further the co-construction of future health care networks.
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Affiliation(s)
- J Nortier
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Erasme, ULB
| | - V Plennevaux
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Erasme, ULB
| | - A Nolf
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Erasme, ULB
| | - J M Hougardy
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Erasme, ULB
| | - A D Petit
- Service Qualité, Hôpital Erasme, ULB
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