Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations

ABSTRACT

In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.

Patient Perceptions of Medical Students' Involvement in Clinical Classes: A Cross-Sectional Survey

Introduction

A crucial aspect of the education of prospective medical professionals is their interaction with patients. The study aimed to explore patients' perspectives on the interaction between medical students and themselves. It sought to understand how patients perceive this dynamic within clinical classes. The goal was to gather insights into the most favorable behavior and demeanor of medical students during these sessions, with the overarching objective of enhancing patient comfort.

Material and Methods

The authors collected a total of 403 surveys from patients of a teaching hospital, regarding their perception of students as healthcare providers. The participants ranged in age from 18 to 92. 53.83% of the participants were female, and 46.17% were male. The surveys were collected between April 8th, 2022, and August 10th, 2022. The results of the anonymous survey undergone statistical analyses using the Mann‒Whitney U-test for comparing two groups and the Kruskal‒Wallis test for comparing more than two groups, because the Shapiro‒Wilk test indicated that the data did not follow a normal distribution.

Results

The study delved into patients' assessments of students' external presentation, adherence to behavioral norms, empathetic qualities, consideration during intimate examinations, and preferences for the organization of clinical classes. Our research indicates notable differences in responses based on age. Specifically, the senior demographic prioritizes students' external presentation, communication and the utilization of courteous language more often than younger individuals (p<0.05). Attendees exhibit varying levels of interest in participating in educational sessions with students based on the ward. Significantly, individuals in the gynecology ward display the least enthusiasm for engagement (p<0.05). Notably, the majority of patients perceive their involvement in the education of future healthcare professionals to be essential (83.38%).

Conclusion

The study found that generally, patients voluntarily engage in educational classes with students. The relationship between patients and students is amicable, and the majority of students display a respectful demeanor toward patients. Nonetheless, preserving patient confidentiality and ensuring the proper management of classes remain persistent issues. This is particularly crucial, especially when the clinical classes pertain to intimate and personal health matters of a patient. Upholding and enriching the organization of such sessions, along with the attentiveness and knowledge of medical students regarding patient comfort, assumes heightened significance.

BioCanRx Summit for Cancer Immunotherapy 2022 Proceedings

From 19 to 21 November 2022, BioCanRx held its first post-pandemic in-person Summit for Cancer Immunotherapy in Montreal, Canada. The meeting was well attended by patients, trainees, researchers, clinicians, and industry professionals, who came together to discuss the current state and future of biotherapeutics for cancer in Canada and beyond. Three plenaries, three keynote speakers, a lively debate, and panel discussions, together with poster sessions and a social event, made the event memorable and productive. The current state of cellular therapies, cellular engineering, clinical trials, and the role of the cancer microbiome were discussed in plenary session, and the patient voice was welcomed and present throughout the meeting, in large part due to the Learning Institute, a BioCanRx initiative to include patient partners in research. In this meeting review, we highlight the platform presentations, keynote speakers, debate combatants, panellists, and the patient perspective on the annual meeting.

Patient Engagement in Provincial and Territorial Medical Association Decision-Making: A Rapid Scoping Review

In recent years health systems have engaged patient partners in decision-making. Provincial and Territorial Medical Associations (PTMAs) are the sole bargaining agents for physicians. PTMA negotiations with governments are often seen as insular. Adding the patient perspective could add tremendous value to negotiating committees, etc. as PTMAs look to advocate for person-centered care provided by their members. Using rapid scoping review methodology, PubMed was searched for studies reporting on the use of patient partners in PTMA decision-making. Title and abstract screening were conducted by a single reviewer with full-text review screened by two reviewers. The search yielded 231 titles with 10 moving to full-text review and ultimately no titles meeting inclusion criteria. This empty scoping review has identified a paucity of literature reporting on patient engagement in PTMA decision-making. Further research is required to determine the utility of introducing patient partners in this capacity.

Innovative Program to Prevent Pediatric Chronic Postsurgical Pain: Patient Partner Feedback on Intervention Development

BACKGROUND

The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain.

METHODS

Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP.

RESULTS

Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials.

CONCLUSIONS

The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve.

Experiences and insights from partners of individuals with single-ventricle CHD: a pilot qualitative research study

INTRODUCTION

With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD.

METHODS

Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes.

RESULTS

Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners' future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future.

CONCLUSIONS

In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.

An Analysis of the #CovidPain Tweet Chat During the First Wave of the COVID-19 Pandemic in 2020

Introduction: In March 2020, we organized two tweet chats to discuss the COVID-19 pandemic and its impact on people affected by chronic pain. The objective of this study is to evaluate the #CovidPain tweet chat activities that took place at the early stages of the COVID-19 pandemic.

Methods: We performed a quantitative analysis of the magnitude, range, engagement, and sentiment of each tweet chat. The data was extracted from Twitter and analyzed in Twitter Analytics and Symplur Signals using frequency and distributions. Then, we conducted a qualitative content analysis of the narrative tweets generated in response to the questions posted during the tweet chats.

Results: The two tweet chats attracted 2305 participants, which generated 4351 tweets. The participants were healthcare providers, patient advocates, researchers/academics, and caregivers. COVID-19 had both negative and positive impacts. The negative consequences of COVID-19 included the reduction of physical activity, canceled appointments and treatments, more isolation, deterioration of preexisting mental health problems, and economic consequences. The positive consequences included efficient use of telemedicine, innovative methods for self-management, and at-home interventions.

Conclusion: Twitter and tweet chats are useful in involving a diverse group of stakeholders for taking a deep dive into the topical issues relevant to a community that might be disproportionately affected by a public health crisis.

Preparing for patient partnership: A scoping review of patient partner engagement and evaluation in research

BACKGROUND

Realizing patient partnership in research requires a shift from patient participation in ancillary roles to engagement as contributing members of research teams. While engaging patient partners is often discussed, impact is rarely measured.

OBJECTIVE

Our primary aim was to conduct a scoping review of the impact of patient partnership on research outcomes. The secondary aim was to describe barriers and facilitators to realizing effective partnerships.

SEARCH STRATEGY

A comprehensive bibliographic search was undertaken in EBSCO CINAHL, and Embase, MEDLINE and PsycINFO via Ovid. Reference lists of included articles were hand-searched.

INCLUSION CRITERIA

Included studies were: (a) related to health care; (b) involved patients or proxies in the research process; and (c) reported results related to impact/evaluation of patient partnership on research outcomes.

DATA EXTRACTION AND SYNTHESIS

Data were extracted from 14 studies meeting inclusion criteria using a narrative synthesis approach.

MAIN RESULTS

Patient partners were involved in a range of research activities. Results highlight critical barriers and facilitators for researchers seeking to undertake patient partnerships to be aware of, such as power imbalances between patient partners and researchers, as well as valuing of patient partner roles.

DISCUSSION

Addressing power dynamics in patient partner-researcher relationships and mitigating risks to patient partners through inclusive recruitment and training strategies may contribute towards effective engagement. Further guidance is needed to address evaluation strategies for patient partnerships across the continuum of patient partner involvement in research.

CONCLUSIONS

Research teams can employ preparation strategies outlined in this review to support patient partnerships in their work.

Cocreating research priorities for anorexia nervosa: The Canadian Eating Disorder Priority Setting Partnership

OBJECTIVE

The Canadian Eating Disorder Priority Setting Partnership was established to identify and prioritize the top 10 research priorities for females, 15 years or older, with anorexia nervosa, by incorporating equal input from those with lived experience, families, and healthcare professionals.

METHOD

This project, which closely followed the James Lind Alliance guidelines, solicited research priorities from the Canadian eating disorder community by means of a five-step process including use of a survey, response collation, literature checking, interim ranking survey, and in-person prioritization workshop.

RESULTS

The initial survey elicited 897 priorities from 147 individuals, with almost equal representation from all three stakeholder groups. From this, 603 responses aligned with the project objectives and were collapsed into 71 broader indicative questions. Based on available systematic reviews, 18 indicative questions were removed as they were considered answered by existing literature while 8 indicative questions were added from the recommendations of the reviews. In total, 61 indicative questions were ranked in an interim ranking survey, where 21 questions were prioritized as important by at least 20% of respondents. As a final step, 28 individuals from across Canada attended the prioritization workshop to coestablish the top 10 research priorities.

DISCUSSION

Top priorities were related to treatment gaps and the need for more surveillance data. This systematic methodology allowed for a transparent and collaborative approach to identifying current priorities from both the service user and provider perspective. Wide dissemination is anticipated to promote work that is of high relevance to patients, families, and clinicians.

Preparing for patient partnership: A scoping review of patient partner engagement and evaluation in research

Background

Realizing patient partnership in research requires a shift from patient participation in ancillary roles to engagement as contributing members of research teams. While engaging patient partners is often discussed, impact is rarely measured.

Objective

Our primary aim was to conduct a scoping review of the impact of patient partnership on research outcomes. The secondary aim was to describe barriers and facilitators to realizing effective partnerships.

Search Strategy

A comprehensive bibliographic search was undertaken in EBSCO CINAHL, and Embase, MEDLINE and PsycINFO via Ovid. Reference lists of included articles were hand‐searched.

Inclusion Criteria

Included studies were: (a) related to health care; (b) involved patients or proxies in the research process; and (c) reported results related to impact/evaluation of patient partnership on research outcomes.

Data Extraction and Synthesis

Data were extracted from 14 studies meeting inclusion criteria using a narrative synthesis approach.

Main Results

Patient partners were involved in a range of research activities. Results highlight critical barriers and facilitators for researchers seeking to undertake patient partnerships to be aware of, such as power imbalances between patient partners and researchers, as well as valuing of patient partner roles.

Discussion

Addressing power dynamics in patient partner‐researcher relationships and mitigating risks to patient partners through inclusive recruitment and training strategies may contribute towards effective engagement. Further guidance is needed to address evaluation strategies for patient partnerships across the continuum of patient partner involvement in research.

Conclusions

Research teams can employ preparation strategies outlined in this review to support patient partnerships in their work.

Engaging older patients with cancer and their caregivers as partners in cancer research

Active patient partner engagement with SCOREboard – a diverse group of older patients with cancer, caregivers of older patients with cancer, survivors, and patient advocates – to conduct the largest randomized geriatric assessment clinical trial to date, has been shown to be feasible and resulted in tangible and invaluable benefits for both the research team and patient partners alike. Actively engaging patient partners should be an essential component in the development, conduct, and completion of all clinical research.