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Bennett AV, O'Brien K, Moreno M, Lanigan K, Maslow K, Malone CA, Hanson LC, Zimmerman S, Karlawish J, Largent EA, Aranda MP, Hinton L, Nicholson BP, Phillips L, Fazio S, Epstein-Lubow G. Development of a Lived Experience Panel to inform the design of embedded pragmatic trials of dementia care interventions. J Am Geriatr Soc 2024; 72:139-148. [PMID: 37787414 PMCID: PMC10841055 DOI: 10.1111/jgs.18621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's Disease and Alzheimer's Related Dementia Clinical Trials (IMPACT) Collaboratory convened a Lived Experience Panel (LEP) to inform the development of research priorities and provide input on conducting embedded pragmatic clinical trials (ePCTs) of dementia care interventions. Given the importance of people with lived experience to dementia research, and the unique considerations of engaging people with dementia, we report on our process for the recruitment, selection, and initial convening of the IMPACT LEP. METHODS The IMPACT Engaging Partners Team, in partnership with the Alzheimer's Association, sought nominations of individuals with mild cognitive impairment or early-stage dementia, care partners of other people living with dementia (PLWD), and proxy representatives for individuals with mid-to-late stage dementia. The 11-member LEP was composed of individuals with diverse personal experiences in part due to their age, race, ethnicity, gender, sexual orientation, geography, disability, or type of dementia. In its first year, the LEP met with IMPACT's Patient and Caregiver Relevant Outcomes Core and Ethics and Regulation Core. RESULTS LEP members provided valuable insights and nuanced discussion of issues relevant to ePCTs in dementia care from a broad range of personal experience. Panelists identified key research priorities and provided insight on outcomes often studied by researchers. The LEP also informed investigators' approaches to waivers and modifications of written informed consent and evaluation of minimal risk. Summary reports of the LEP meetings with each Core are available on the IMPACT website. At the end of the first year, changes were made to the composition of the LEP, and opportunities were identified for expanding panelist engagement with IMPACT investigators, as were priorities and scope for future input. CONCLUSIONS The IMPACT LEP provides a model for engaging PLWD and care partners in the research process as collaborators.
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Affiliation(s)
- Antonia V Bennett
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kyra O'Brien
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Monica Moreno
- Care and Support, Alzheimer's Association, Chicago, Illinois, USA
| | - Kerry Lanigan
- Care and Support, Alzheimer's Association, Chicago, Illinois, USA
| | - Katie Maslow
- The Gerontological Society of America, Washington, DC, USA
| | - Carolyn A Malone
- Department of Health Services, Policy, and Practice, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Laura C Hanson
- Division of Geriatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason Karlawish
- Penn Memory Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - María P Aranda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Brenda P Nicholson
- NIA IMPACT Engaging Partners Team, Emeritus, Providence, Rhode Island, USA
| | - Louise Phillips
- NIA IMPACT Engaging Partners Team, Emeritus, Providence, Rhode Island, USA
| | - Sam Fazio
- Quality Care and Psychosocial Research, Alzheimer's Association, Chicago, Illinois, USA
| | - Gary Epstein-Lubow
- Education Development Center, Waltham, Massachusetts, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Hamm ME, Arnold J, Denson J, Edwards T, Merritt G, McCarthy M, Nelson D, Phillips KT, Thicklin F, Vasey A, McTigue K. The ACTIV-6 Stakeholder Advisory Committee: a model for virtual engagement in decentralized clinical trials. J Clin Transl Sci 2023; 7:e264. [PMID: 38229896 PMCID: PMC10789984 DOI: 10.1017/cts.2023.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Engaging patients, caregivers, and other stakeholders to help guide the research process is a cornerstone of patient-centered research. Lived expertise may help ensure the relevance of research questions, promote practices that are satisfactory to research participants, improve transparency, and assist with disseminating findings. Methods Traditionally engagement has been conducted face-to-face in the local communities in which research operates. Decentralized platform trials pose new challenges for the practice of engagement. We used a remote model for stakeholder engagement, relying on Zoom meetings and blog communications. Results Here we describe the approach used for research partnership with patients, caregivers, and clinicians in the planning and oversight of the ACTIV-6 trial and the impact of this work. We also present suggestions for future remote engagement. Conclusions The ACTIV-6 experience may inform proposed strategies for future engagement in decentralized trials.
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Affiliation(s)
- Megan E. Hamm
- Division of General Internal Medicine, University of
Pittsburgh, Pittsburgh, PA,
USA
| | - Jonathan Arnold
- Division of General Internal Medicine, University of
Pittsburgh, Pittsburgh, PA,
USA
| | - Josh Denson
- Section of Pulmonary, Critical Care, and Environmental Medicine,
Tulane University School of Medicine, New Orleans,
LA, USA
| | | | | | - Matthew McCarthy
- Department of Medicine, Weill Cornell Medicine,
New York, NY, USA
| | - Danielle Nelson
- Department of Community Health and Family Medicine,
University of Florida College of Medicine,
Gainesville, FL, USA
| | - Kirk T. Phillips
- Department of Epidemiology, University of Iowa,
Iowa City, IA, USA
| | | | - Andrew Vasey
- Division of General Internal Medicine, University of Nebraska
Medical Center, Omaha, NE,
USA
| | - Kathleen McTigue
- Division of General Internal Medicine, University of
Pittsburgh, Pittsburgh, PA,
USA
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Providers' Perspectives on High-Quality Dementia Care in Long-Term Care. J Am Med Dir Assoc 2022; 23:2030.e1-2030.e8. [PMID: 36058295 DOI: 10.1016/j.jamda.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To understand dementia care providers' perspectives on high-quality care for persons living with dementia (PLWD) in long-term care (LTC). DESIGN A qualitative study using a directed content analysis approach. SETTING AND PARTICIPANTS Nine national LTC dementia care providers. METHODS We facilitated 5 listening sessions centered around dementia care philosophies, models, and practices. Two researchers first mapped qualitative data to the Holistic Approach to Transformational Change (HATCh) model for dementia care using a directed content analysis approach. They then identified themes and subthemes emerging from the data using a conventional analysis approach. They coded data iteratively and solicited input from 3 additional researchers to reach consensus where needed. Member checks were performed to ensure the trustworthiness of the data during 2 follow-up listening sessions. RESULTS The 9 participants described the importance of understanding the experiences of PLWDs in order to provide high-quality dementia care and to deliver such care with the residents and their preferences as the focus. They emphasized experiential education as essential for families and all staff, regardless of role. They noted the need to balance safety with resident choice, as well as the corresponding need for facility leadership and regulators to support such choices. The listening sessions revealed areas to foster person-centered care for PLWD, but also highlighted barriers to implementing this philosophy in LTC settings. CONCLUSIONS AND IMPLICATIONS Emergent themes included care practices that center on resident preferences and are supported by staff with the experiential education and communication skills necessary to relate to and support PLWD. These findings provide contextual information for researchers seeking to identify and test interventions that reflect LTC providers' priorities for PLWD and emphasize the need to align research priorities with provider priorities.
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Patel NK, Masoud SS, Meyer K, Davila AV, Rivette S, Glassner AA, James D, White CL. Engaging multi-stakeholder perspectives to identify dementia care research priorities. J Patient Rep Outcomes 2021; 5:46. [PMID: 34156561 PMCID: PMC8218276 DOI: 10.1186/s41687-021-00325-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to partner with stakeholders to identify gaps in care for persons living with dementia and their family caregivers and from this list, identify priorities for dementia care research. METHODS Using a community-engaged research approach, a Stakeholder Advisory Council (SAC) consisting of diverse membership including persons living with dementia and family caregivers was convened. Through our work with the SAC, along with input from the wider network through a symposium, webinars, and an online learning community, gaps in dementia care and a list of topics for dementia care research was generated. This list was reduced to 46 topics for dementia care research and sent to stakeholders (persons living with dementia, family caregivers, and health/social care professionals in dementia care) to be prioritized by rating each of the 46 topics as "Not so important," "Important," or "Very important." Priorities for dementia care were summarized by frequencies and proportions. RESULTS A total of 186 participants completed the survey from August through October 2020, including 23 (12.4%) persons living with dementia, 101 (54.3%) family caregivers, and 62 (33.3%) health/social care professionals. Consistent across stakeholder groups was the focus on research on how best to support families following a diagnosis of dementia. Among persons living with dementia, research focused on support for continuing to live in their own homes was ranked as the highest priority, rated by 91.3% as "Very Important". High priority research areas for family caregivers included interventions to slow cognitive decline (76.3%) as well as non-pharmacological approaches to manage behavioral symptoms (74.7%). The highest priority research topics for health/social care professionals were focused on the diagnosis including benefits of an early diagnosis (71.4%), how best to deliver the diagnosis (70.9%), and supports needed following a diagnosis (78.6%). CONCLUSIONS This project draws on the strengths of its multi-stakeholder perspective to support patient-centered outcomes research. Findings are intended to inform those who conduct research and those who fund research about which research topics stakeholders believe are most important and thus have greatest potential to improve the quality of life among people living with dementia and their families.
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Affiliation(s)
- Neela K Patel
- Geriatrics and Supportive Care, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Sara S Masoud
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Angelica V Davila
- Geriatrics and Supportive Care, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Sheran Rivette
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Ashlie A Glassner
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Deborah James
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Carole L White
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA.
- Caring for the Caregiver Program, School of Nursing, UT Health San Antonio, San Antonio, Texas, USA.
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Ouslander JG, Reyes B, Yang Z, Engstrom G, Tappen R, Newman D, Huckfeldt PJ. Nursing home performance in a trial to reduce hospitalizations: Implications for future trials. J Am Geriatr Soc 2021; 69:2316-2326. [PMID: 34018181 DOI: 10.1111/jgs.17231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. DESIGN Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. PARTICIPANTS Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. MEASUREMENTS Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. RESULTS The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. CONCLUSION Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director.
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Affiliation(s)
- Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.,Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Bernardo Reyes
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Zhiyou Yang
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabriella Engstrom
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Peter J Huckfeldt
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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