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Tiemens DK, Kleimeier L, Leenders E, Wingbermühle E, Roelofs RL, Sibbles B, Oostwegel FSM, Vroonland E, van Leeuwen C, Niessen H, Sonnega P, Duursma A, Willemsen MAAP, Draaisma JMT, Pittens CACM. The most important problems and needs of rasopathy patients with a noonan syndrome spectrum disorder. Orphanet J Rare Dis 2023; 18:198. [PMID: 37480127 PMCID: PMC10362585 DOI: 10.1186/s13023-023-02818-y] [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: 12/29/2022] [Accepted: 07/08/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Noonan syndrome spectrum disorders (NSSDs) constitute a group within the Rasopathies, and are one of the largest groups of syndromes with impact on multi-organ involvement known. The extreme variability of the clinical phenotype is, among others, due to the numerous different genes that are involved, and the differences in clinical presentation over the life span. We have studied the needs of patients and their relatives aiming to develop, evaluate and choose focus in research, medical care and policy to better meet their perspectives. METHODS Using the participatory and interactive Dialogue method, 80 patients and relatives mentioned 53 different problems or needs (topics) that were categorized into eight themes. These themes and the topics within each theme, were subsequently prioritized by putting them in order of importance methodologically. RESULTS The four highest prioritized themes were: (1) Physical problems (non-musculoskeletal related); (2) Social, emotional and behavioral problems; (3) Cognitive functioning and information processing; and (4) Problems related to the musculoskeletal system. Nineteen out of the 53 topics were physical problems. According to the total group of respondents, the top 3 prioritized topics within theme 1 were coagulation problems, heart problems, and feeding problems. Also data stratified by age groups, phenotype (NS and other NSSDs) and gender showed some remarkable results. For instance, feeding problems were prioritized as the most important topic of the highest prioritized theme, according to patients aged 0-12 years. Also feeding problems show a significant difference in its prioritization according to female patients (2) compared to male patients (7). On the other hand, heart problems were not mentioned in the top three prioritized topics in the youngest age groups, although heart problems are generally considered most important for patients with NSSD. CONCLUSIONS With our results we underline the importance of methodologically inventorying the needs of NSSD patients, not only at the group level, but to also focus on specific needs according to e.g. age, phenotype and gender. For instance, it is remarkable that both the current Clinical Guidelines and the Noonan Syndrome diagnostic criteria give little to no attention to feeding problems, though our results indicate that, to the youngest patients, these problems have top priority. A similar situation appears to apply to the clinical management of e.g. coagulation, neuropsychological and musculoskeletal problems (like physiotherapy or occupational therapy) and to a need for (educational) tools to support patients at school or at work. Our study may help to shape targeted (clinical) management, research and policy inside and outside medical (research) institutes and shed light on the complex phenotypes of NSSDs, the families' and patients' perspectives on the everyday consequences of the many different problems, as well as their needs.
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Affiliation(s)
- Dagmar K Tiemens
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
- Dutch Noonan Syndrome Foundation, Nijkerk, The Netherlands
| | - Lotte Kleimeier
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Erika Leenders
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Wingbermühle
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Amalia Children's Hospital Nijmegen, Nijmegen, The Netherlands
| | - Renee L Roelofs
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Amalia Children's Hospital Nijmegen, Nijmegen, The Netherlands
| | - Barbara Sibbles
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Floor S M Oostwegel
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | | | | | | | - Paul Sonnega
- Dutch Noonan Syndrome Foundation, Nijkerk, The Netherlands
| | - Anniek Duursma
- Dutch Noonan Syndrome Foundation, Nijkerk, The Netherlands
| | - Michel A A P Willemsen
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
- Department of Pediatrics, Donders Institute for Brain, Cognition and Behavior, Amalia Children's Hospital Nijmegen, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands.
| | - Carina A C M Pittens
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
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Harmsen S, Nabuurs JA, Lehman de Lehnsfeld LF, van der Meij MG, Broerse JEW, Pittens CACM. Mapping the complex everyday challenges and needs of people with rheumatic disease and their surroundings using a multi-actor approach. Musculoskeletal Care 2022; 20:873-891. [PMID: 35478485 PMCID: PMC10084345 DOI: 10.1002/msc.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION This study aimed to gain insight into the real-world complexity of the challenges experienced by patients, their significant others, care professionals and the work and education environment concerning rheumatic diseases as well as the interrelation between these challenges; it also aimed to prioritise the identified challenges. METHOD Using the Dialog Model, 21 people with various rheumatic diseases, 24 care professionals, 9 significant others, and 3 education and work representatives were asked about rheumatic disease-related challenges and needs in a series of focus groups and interviews. Data were inductively coded and analysed, resulting in a mind map thematically displaying the challenges. The mind map was translated into a survey, and respondents (N = 1802) prioritised themes and challenges. RESULTS Of the six identified themes, 'physical complaints' was prioritised the most, followed by 'collaboration in healthcare', 'social and mental wellbeing', 'self-management', 'information and options in healthcare' and 'work and education'. Challenges of people with rheumatic diseases appeared to be complexly interrelated. For instance, fatigue and pain affect everyday functioning, but can also heavily impact social and mental wellbeing. To facilitate support for these challenges, which many patients desire, patients and care professionals said that better collaboration between primary and secondary care professionals is needed. Additionally, patients felt that their experiential expertise deserves more acknowledgement from care professionals. Results were similar across different rheumatic diseases. CONCLUSION Many patients desire more support to manage life with their disease. To facilitate this, collaboration and communication between healthcare professionals, and between healthcare professionals and individual patients, should be improved.
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Affiliation(s)
- Simone Harmsen
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Joyce A Nabuurs
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands.,Dutch Arthritis Society, Amsterdam, The Netherlands
| | | | | | - Jacqueline E W Broerse
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Carina A C M Pittens
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands
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Geurts EMA, Pittens CACM, Boland G, van Dulmen S, Noordman J. Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care. Patient Educ Couns 2022; 105:1130-1137. [PMID: 34456095 DOI: 10.1016/j.pec.2021.08.022] [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: 01/21/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Both patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations. METHODS An exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings. RESULTS 24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings. CONCLUSIONS Persuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact. PRACTICE IMPLICATIONS Awareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.
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Affiliation(s)
- Esther M A Geurts
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands; Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
| | | | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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4
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Tiemens DK, Nugteren J, Leenders E, Wingbermühle E, Pittens CACM, Draaisma JMT. Patient engagement in the design of clinical research in Noonan syndrome spectrum disorders: a scoping review. Orphanet J Rare Dis 2021; 16:449. [PMID: 34702330 PMCID: PMC8549341 DOI: 10.1186/s13023-021-02083-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Noonan syndrome spectrum disorders are a group of disorders caused by mutations in several genes of the RAS/MAPK pathway. Because of a highly heterogeneity and variable phenotypical manifestations of the disorders, these children and adults have a variable number of symptoms. Inclusion of their perceived experience of their health and developmental problems in research (design) could contribute to increased relevance of the research process and outcomes. The aim of this study is to get insight in what way patients with a Noonan syndrome spectrum disorder have been involved in the research process in order to learn for future engagement practices. Methods and results To that end, the degree of engagement was measured by the eight levels of the participation ladder of Arnstein. Using a scoping review approach, 18 articles were selected in which patient engagement in the design of studies in patients with Noonan syndrome spectrum disorders was described over the past twenty years. Six of these articles reported engagement on the level of informing (level 3), 8 on the level of consultation (level 4), 2 on the level of placation (level 5)and 2 on the level of partnership (level 6). Conclusions The current results do show a positive albeit still modest development of patient engagement over the last few years. A promising way to stimulate engagement is aiming to yield insights in the most important patients’ needs by developing a patient guided research agenda. However, this is not automatically followed by patient engagement at higher levels of participation in subsequent research steps. For this reason, in the Netherlands for example, a Dutch Noonan syndrome spectrum disorders research agenda is being developed, in a collaboration between the Dutch Noonan Syndrome Foundation and national scientific and clinical professionals.
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Affiliation(s)
- Dagmar K Tiemens
- Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Dutch Noonan Syndrome Foundation, Nijkerk, The Netherlands
| | - Jacqueline Nugteren
- Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erika Leenders
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Wingbermühle
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre of Excellence for Neuropsychiatry, Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Jos M Th Draaisma
- Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Goedhart NS, Pittens CACM, Tončinić S, Zuiderent-Jerak T, Dedding C, Broerse JEW. Engaging citizens living in vulnerable circumstances in research: a narrative review using a systematic search. Res Involv Engagem 2021; 7:59. [PMID: 34479622 PMCID: PMC8414765 DOI: 10.1186/s40900-021-00306-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Although public engagement in research is increasingly popular, the involvement of citizens living in vulnerable circumstances is rarely realized. This narrative review aims to describe and critically analyse concerns and corresponding strategies, tools, and methods that could support the inclusion of these citizens in health research. The 40 studies that are included were thematically analysed using the socioecological model. Concerns originate most often on the intrapersonal level of the socioecological model, but concerns were also identified at institutional, community, and policy levels. It is thought-provoking that there is a lack of attention for the research and policy structure in which engagement practices are designed, implemented and evaluated. More research is needed to explore how these cultures could be changed in a way that promotes rather than restrains the engagement of citizens living in vulnerable circumstances in research and policymaking.
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Affiliation(s)
- N S Goedhart
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands.
| | - C A C M Pittens
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Tončinić
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Dedding
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - J E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hilverda F, van der Wouden P, van der Heijden GJMG, Pittens CACM. A research agenda on oral health care as a boundary object that unites the perspectives of patients and practitioners. Health Expect 2021; 24:1701-1712. [PMID: 34312967 PMCID: PMC8483215 DOI: 10.1111/hex.13310] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
Context A research agenda for oral health care was established in the Netherlands using the Dialogue Model. This project served as a case study in which we applied boundary‐work theory as a framework to understand boundaries (ie demarcations) between and within groups, and how these boundaries can be overcome. Objective To gain insights into the boundaries encountered when setting a research agenda, we analysed how this agenda served as a boundary object (ie circumstances, situations or material that connect actor groups and allow boundary crossing) that facilitated crossing boundaries and uniting the perspectives of patients and practitioners. Methods We used a thematic approach to analyse researchers' observations, meeting materials, emails, interviews with patients (n = 11) and a survey among patients and practitioners (n = 18). Results Setting the research agenda helped to cross boundaries in oral health care, which demonstrates its role as a boundary object. First, this made it possible to integrate research topics representing the perspectives and priorities of all patients and also to unite those perspectives. It was essential to involve practitioners at an early stage of the project so that they could better accept the patients' perspectives. This resulted in support for an integrated research agenda, which facilitated the crossing of boundaries. Conclusions The research agenda‐setting project was found to serve as a boundary object in uniting the perspectives and priorities of patients and practitioners. Patient contribution Patient involvement in this case study was structured in the process of research agenda setting using the Dialogue Model.
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Affiliation(s)
- Femke Hilverda
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Puck van der Wouden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, VU University Amsterdam, Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, VU University Amsterdam, Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Carina A C M Pittens
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
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Petit-Steeghs V, Pittens CACM, Barnhoorn MJM, Broerse JEW. "The challenge of managing insecurities": Parents' experiences with the care for their child with congenital diaphragmatic hernia. J SPEC PEDIATR NURS 2019; 24:e12247. [PMID: 31025826 PMCID: PMC6767506 DOI: 10.1111/jspn.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Last decennia remarkable advances have been made in decreasing the mortality rate of children with congenital diaphragmatic hernia (CDH), resulting in a relatively growing patient group with long-term complications and complex care needs. These consequences have a huge impact on the quality of life of both children and their families. To provide practical recommendations for improving the quality of care for this patient group, the present study sought to obtain insights into the experiences and needs of parents with a child with CDH. DESIGN AND METHODS A qualitative study was conducted on the experiences and needs of parents with a child with CDH living in the Netherlands. Data was obtained by means of a discourse analyses of 17 weblogs written by parents and three online focus groups with 8-12 parents per group (n = 29). The data was analysed thematically and structured by using the model of Lawoko (2007) on parental satisfaction with care. RESULTS Although parents were generally satisfied with the delivered care, they frequently encountered challenges in managing insecurities throughout the care process. Besides the unpredictable disease progress, insecurities were exacerbated by: (a) limited specialized knowledge of long-term consequences, (b) logistical problems, and (c) nontransparent communication. Providing security through, for instance, a clear care plan and by engaging parents in the decision-making process helped them feel more in control. PRACTICE IMPLICATIONS This study showed that parents' main challenge was to manage insecurities. Creating securities by providing a care plan and involving parents in the decision-making process helped parents to feel more in control. To improve quality of care for children with CDH, future measures should, therefore, focus on reducing insecurities by managing expectations, improving transparency and stimulating engagement.
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Schölvinck AFM, Pittens CACM, Broerse JEW. The Research Priorities of People with Visual Impairments in the Netherlands. Journal of Visual Impairment & Blindness 2017. [DOI: 10.1177/0145482x1711100302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Despite the relatively high prevalence and challenges of visual impairments, limited funding is available for ophthalmologic research in the Netherlands. The research needs of people with visual impairments could aid the ophthalmological research community to optimally distribute research resources. The objective of the study presented here was to identify daily life problems, concerns, and wishes for future research from people with ophthalmological disorders, visual impairments, or deafblindness in order to set a research agenda that provides directions for future ophthalmology research. Methods A four-phase participatory research approach was carried out using mixed methods to stimulate needs-articulation. Eight focus group discussions, seven feedback meetings, and seven interviews were organized, in which 89 consumers were consulted. Surveys to prioritize the topics were developed for both the medical and sociopsychological topics, which were completed by 784 and 631 respondents, respectively. Results For the medical research agenda, research directly aimed at the cause of the ophthalmological disorders was considered more important than research aimed at improving quality of life. The themes “new and regenerative medicine,” “cause and disease mechanism,” “prevention and diagnosis,” and “improvement of current treatments” were prioritized as high. For the sociopsychological agenda, needs concerning the “improvement of technologies for people with visual impairments” and “navigation, orientation, and accessibility of public space” were considered top priorities. Discussion The identified research needs were relatively uniform across different consumer groups, providing opportunities for joint action. The research agenda included themes that can be taken up by “traditional” ophthalmological research, more broadly defined health care–related research, and more policy-influencing strategies. Implications for practitioners The research needs could help researchers and policymakers in ophthalmology and visual impairment research to guide their research focus and legislation priorities.
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Affiliation(s)
- Anne-Floor M. Schölvinck
- Athena Institute, Free University Amsterdam de Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Carina A. C. M. Pittens
- Vilans Center of Expertise for Long-Term Care, Catharijnesingel 47, Postbus 8228, 3503 RE Utrecht, the Netherlands
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9
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van de Burgwal LHM, Neevel AMG, Pittens CACM, Osterhaus ADME, Rupprecht CE, Claassen E. Barriers to innovation in human rabies prophylaxis and treatment: A causal analysis of insights from key opinion leaders and literature. Zoonoses Public Health 2017; 64:599-611. [PMID: 28318148 DOI: 10.1111/zph.12352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Indexed: 12/25/2022]
Abstract
Rabies is an essentially 100% fatal, zoonotic disease, caused by Lyssaviruses. Currently, the disease is vaccine-preventable with pre- and post-exposure prophylaxis (PrEP and PEP). Still, rabies virus is estimated to cause up to 60,000 human deaths annually, of which the vast majority occurs in rural Asia and Africa, due to the inaccessibility of prophylaxis and non-existence of treatment. Despite these unmet clinical needs, rabies control mainly focuses on the sylvatic reservoir and drug innovation receives relatively little attention compared to other neglected tropical diseases (NTDs). As such, the lag of innovation in human rabies prophylaxis and treatment cannot be explained by limited return on investment alone. Strategies countering rabies-specific innovation barriers are important for the acceleration of innovation in human rabies prophylaxis and treatment. Barriers throughout society, science, business development and market domains were identified through literature review and 23 semi-structured interviews with key opinion leaders worldwide. A subsequent root cause analysis revealed causal relations between innovation barriers and a limited set of root causes. Finally, prioritization by experts indicated their relative importance. Root causes, which are fundamental to barriers, were aggregated into four types: market and commercial, stakeholder collaboration, public health and awareness, and disease trajectory. These were found in all domains of the innovation process and thus are relevant for all stakeholders. This study identifies barriers that were not previously described in this specific context, for example the competition for funding between medical and veterinary approaches. The results stress the existence of barriers beyond the limited return on investment and thereby explain why innovation in human rabies medication is lagging behind NTDs with a lower burden of disease. A re-orientation on the full spectrum of barriers that hinder innovation in rabies prophylaxis and treatment is necessary to meet unmet societal and medical needs.
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Affiliation(s)
- L H M van de Burgwal
- Athena Institute, VU University, Amsterdam, The Netherlands.,Artemis One Health, Utrecht, The Netherlands
| | - A M G Neevel
- Athena Institute, VU University, Amsterdam, The Netherlands.,Viroclinics Biosciences, Rotterdam, The Netherlands
| | | | - A D M E Osterhaus
- Artemis One Health, Utrecht, The Netherlands.,Viroclinics Biosciences, Rotterdam, The Netherlands.,University of Veterinary Medicine, Hannover (RIZ), Germany
| | | | - E Claassen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Artemis One Health, Utrecht, The Netherlands.,Viroclinics Biosciences, Rotterdam, The Netherlands
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Pittens CACM, Vonk Noordegraaf A, van Veen SC, Anema JR, Huirne JAF, Broerse JEW. The involvement of gynaecological patients in the development of a clinical guideline for resumption of (work) activities in the Netherlands. Health Expect 2015; 18:1397-412. [PMID: 23992108 PMCID: PMC5060877 DOI: 10.1111/hex.12121] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Accepted: 07/23/2013] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Most initiatives for patient involvement in guideline development have been carried out for chronic diseases. The involvement of patients with incidental and non-threatening diseases is more complicated. Little knowledge is available on how these patient groups can successfully be involved in guideline development. OBJECTIVE To assess the effectiveness of the involvement of gynaecological patients in the guideline development for resumption of (work) activities after surgery. DESIGN At three different stages patients were involved in the process: (i) three focus group discussions (FGDs) were organized, (ii) patients were involved for the instruction video, and (iii) patients tested the patient version of the clinical guideline. To assess the effectiveness, an evaluation framework was used. The guideline development process was divided into two parallel trajectories in which patients and professionals were consulted separately. Patients were primarily consulted for the development of the patient version, although their input also influenced the recommendations for resumption of (work) activities after surgery. Professionals were mainly involved in the development of the recommendations of the clinical guideline. DISCUSSION AND CONCLUSIONS The involvement of gynaecological patients in the guideline development for resumption of (work) activities after surgery was successful in many respects. Consultation of individual patients by means of FGDs and with regular feedback moments has been rather effective for a guideline development process related to an incidental, non-threatening disease for which there is no patient organization. Patients' input contributed to applicability of the clinical guideline in daily practice. Increased patient involvement could be achieved by integration of the two parallel trajectories with additional participatory activities, such as a dialogue meeting.
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Affiliation(s)
- Carina A C M Pittens
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Antonie Vonk Noordegraaf
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Saskia C van Veen
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline E W Broerse
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
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van der Veer SN, Haller MC, Pittens CACM, Broerse J, Castledine C, Gallieni M, Inston N, Marti Monros A, Peek N, van Biesen W. Setting Priorities for Optimizing Vascular Access Decision Making--An International Survey of Patients and Clinicians. PLoS One 2015; 10:e0128228. [PMID: 26151822 PMCID: PMC4494812 DOI: 10.1371/journal.pone.0128228] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/07/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many decisions around vascular access for haemodialysis warrant a collaborative treatment decision-making process, involving both clinician and patient. Yet, patients' experiences in this regard have been suboptimal. Although clinical practice guidelines could facilitate collaborative decision making, they often focus on the clinicians' side of the process, while failing to address the patients' perspective. The objective of this study was to explore and compare kidney patients' and clinicians' views on what vascular access-related decisions deserved priority for developing guidelines that will contribute to optimizing collaborative decision making. METHODS In the context of updating their vascular access guideline, European Renal Best Practice surveyed an international panel of 85 kidney patients, 687 nephrologists, 194 nurses, and 140 surgeons/radiologists. In an electronic questionnaire, respondents rated 42 vascular access-related topics on a 5-point Likert scale. Based on mean standardized ratings, we compared priority ratings between patients and each clinician group. RESULTS Selection of access type and site, as well as prevention of access infections received top priority across all respondent groups. Patients generally assigned higher priority to decisions regarding managing adverse effects of arteriovenous access and patient involvement in care, while clinicians more often prioritized decisions around sustaining patients' access options, technical aspects of access creation, and optimizing fistula maturation and patency. CONCLUSION Apart from identifying the most pressing knowledge gaps, our study provides pointers for developing guidelines that may improve healthcare professionals' understanding of when to involve patients along the vascular access pathway.
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Affiliation(s)
- Sabine N. van der Veer
- European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium
- Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Maria C. Haller
- European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University Vienna, Vienna, Austria
- Department for Internal Medicine III, Nephrology and Hypertension Diseases, Transplantation Medicine and Rheumatology, Krankenhaus Elisabethinen, Linz, Austria
| | - Carina A. C. M. Pittens
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU university, Amsterdam, the Netherlands
| | - Jacqueline Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU university, Amsterdam, the Netherlands
| | - Clare Castledine
- Sussex Kidney Unit, Brighton & Sussex University Hospital, Brighton, United Kingdom
| | - Maurizio Gallieni
- Vascular Access Society (VAS), Maastricht, the Netherlands
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Milano, Italy
| | - Nicholas Inston
- Vascular Access Society of Britain and Ireland (VASBI), Glasgow, United Kingdom
- Department of Renal Transplantation and Renal Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | - Niels Peek
- Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Wim van Biesen
- European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium
- Renal division, University Hospital Ghent, Ghent, Belgium
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Abma TA, Pittens CACM, Visse M, Elberse JE, Broerse JEW. Patient involvement in research programming and implementation: A responsive evaluation of the Dialogue Model for research agenda setting. Health Expect 2014; 18:2449-64. [PMID: 24889933 DOI: 10.1111/hex.12213] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Dialogue Model for research agenda-setting, involving multiple stakeholders including patients, was developed and validated in the Netherlands. However, there is little insight into whether and how patient involvement is sustained during the programming and implementation of research agendas. AIM To understand how the Dialogue Model can be optimised by focusing on programming and implementation, in order to stimulate the inclusion of (the perspectives of) patients in research. METHODS A responsive evaluation of the programming and implementation phases of nine agenda-setting projects that had used the Dialogue Model for agenda-setting was conducted. Fifty-four semi-structured interviews were held with different stakeholders (patients, researchers, funding agencies). Three focus groups with patients, funding agencies and researchers (16 participants) were organized to validate the findings. RESULTS Patient involvement in programming and implementation of the research agendas was limited. This was partly related to poor programming and implementation, partly to pitfalls in earlier phases of the agenda-setting. Optimization of the Dialogue Model is possible by attending to the nature of the agenda and its intended use in earlier phases. Attention should also be given to the ambassadors and intended users of agenda topics. Support is needed during programming and implementation to organize patient involvement and adapt organizational structures like review procedures. In all phases the attitude to patient involvement, stakeholder participation, especially of researchers, and formal and informal relationships between parties need to be addressed to build a strong relationship with a shared goal. CONCLUSION Patient involvement in agenda-setting is not automatically followed by patient involvement in programming and implementation. More attention should be paid, in earlier stages, to the attitude and engagement of researchers and funding agencies.
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Affiliation(s)
- Tineke A Abma
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Carina A C M Pittens
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Merel Visse
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Janneke E Elberse
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Jacqueline E W Broerse
- Faculty of Earth and Life Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
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Pittens CACM, Bouman HJ, van Werkum JW, ten Berg JM, Hackeng CM. Comparison between hirudin and citrate in monitoring the inhibitory effects of P2Y12 receptor antagonists with different platelet function tests. J Thromb Haemost 2009; 7:1929-32. [PMID: 19691484 DOI: 10.1111/j.1538-7836.2009.03585.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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