Report of a Delphi exercise to inform the design of a research programme on screening for thoracic aortic disease

A Delphi study to identify and prioritize research areas in sickle cell disease in India

Sickle Cell Disease (SCD) poses a significant health burden in India, necessitating comprehensive research to address its complex challenges. This Delphi study engaged a diverse panel of experts and stakeholders to identify and prioritize critical research questions on SCD in India. A total of 74 experts participated in the process of prioritizing research questions in SCD. In the first Delphi round, 52 participants, including scientists, clinicians, policymakers, and representatives from governmental and non-governmental organizations, attended this meeting, where 163 SCD research areas were generated. These areas were refined by the Delphi team in consultation with the core working group, and 16 priority questions were circulated to 81 experts (of which 65 responded) for rating 3 top priority questions. The study revealed three key research priorities: implementation research considering community perceptions addressing stigma, improving diagnostic methods, and developing affordable treatment options. Experts also emphasized the need for patient-centered research, addressing psychosocial challenges, and incorporating innovative treatments and diagnostic tools. The findings provide important insights for advancing SCD research and inform the direction of future SCD research in India, focusing on early detection, innovative treatments, and patient-centered care.

Reporting the involvement of patients and caregivers in identifying and designing healthcare interventions: the IDEAS framework

BACKGROUND AND OBJECTIVE

Patient and caregiver involvement can optimize the relevance and uptake of research. However, there is little guidance on approaches for reporting the involvement of patients and caregivers in the identification and design of health care interventions. This study aims to develop a reporting framework for involving patients and caregivers in identifying and designing health care interventions to improve transparency in the approaches used.

METHODS

Electronic literature databases were extensively searched for guidelines, frameworks, reviews, and primary studies that reported patient and caregiver involvement in interventions; studies identified up to April 2024 were identified. A comprehensive list of reporting items was inductively developed. The IDEntifying And designing healthcare interventionS (IDEAS) framework was piloted with a diverse range of primary studies that reported patient and caregiver involvement in interventions.

RESULTS

Nineteen secondary studies (eg, guidelines, frameworks, and reviews) and 41 primary studies were used to develop the reporting items for the IDEAS framework. The IDEAS framework includes 14 reporting items that cover five domains: purpose (ie, role of patients or caregivers, type and scope of interventions, criteria considered eg, acceptability, feasibility); theory or framework used; population (ie, inclusion criteria, identification and selection, and characteristics); mode of involvement (ie, process of involvement, frequency, duration, and reimbursement); and output and impact. Each reporting item includes a descriptor and examples.

CONCLUSION

The IDEAS framework can help ensure transparency in describing the process of reporting patients and caregivers in identifying and designing health care interventions. Ultimately, this may support the design of interventions that address the needs, preferences and priorities of patients and caregivers.

PLAIN LANGUAGE SUMMARY

Patient and caregiver involvement in identifying and designing health care interventions can help improve acceptability, uptake, and impact of interventions. However, there is little guidance that addresses the reporting of the involvement of patients and caregivers in developing health care interventions. We carried out a detailed search for guidelines, frameworks, and primary studies to develop the reporting of the involvement of patients and caregivers in IDEentifying And designing healthcare interventionS (IDEAS) framework. The IDEAS framework consists of 14 reporting items that cover five domains: the purpose of involvement, the theory or framework used, the population of patients and caregivers who were involved, mode of involvement (ie, process of involvement), and output and impact. The IDEAS framework can be used to describe the involvement of patients and caregivers in identifying and designing health care interventions.

Evaluating the Feasibility of Screening Relatives of Patients Affected by Nonsyndromic Thoracic Aortic Diseases: The REST Study

Background

Diseases of the thoracic aorta are characterized by a familial etiology in up to 30% of the cases. Nonsyndromic thoracic aorta diseases (NS‐TADs) lack overt clinical signs and systemic features, which hinder early detection and prompt surgical intervention. We hypothesize that tailored genetic testing and imaging of first‐degree and second‐degree relatives of patients affected by NS‐TADs may enable early diagnosis and allow appropriate surveillance or intervention.

Methods and Results

We conducted a feasibility study involving probands affected by familial or sporadic NS‐TADs who had undergone surgery, which also offered screening to their relatives. Each participant underwent a combined imaging (echocardiogram and magnetic resonance imaging) and genetic (whole exome sequencing) evaluation, together with physical examination and psychological assessment. The study population included 16 probands (8 sporadic, 8 familial) and 54 relatives (41 first‐degree and 13 second‐degree relatives) with median age 48 years (range: 18–85 years). No syndromic physical features were observed. Imaging revealed mild‐to‐moderate aortic dilation in 24% of relatives. A genetic variant of uncertain significance was identified in 3 families. Imaging, further phenotyping, or a form of secondary prevention was indicated in 68% of the relatives in the familial group and 54% in the sporadic group. No participants fulfilled criteria for aortic surgery. No differences between baseline and 3‐month follow‐up scores for depression, anxiety, and self‐reported quality of life were observed.

Conclusions

In NS‐TADs, imaging tests, genetic counseling, and family screening yielded positive results in up to 1 out of 4 screened relatives, including those in the sporadic NS‐TAD group.

Registration

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03861741.

Current state and future directions of genomic medicine in aortic dissection: A path to prevention and personalized care

Aortic dissection confers high mortality and morbidity rates despite advances in treatment, impacts quality of life, and contributes immense burden to the healthcare system globally. Efforts to prevent aortic dissection through screening and management of modifiable risk factors and early detection of aneurysms should incorporate genomic information, as it is integral to stratifying risk. However, effective integration of genomic-guided risk assessment into clinical practice will require addressing implementation barriers that currently permeate our healthcare systems. The Aortic Dissection Collaborative was established to define aortic dissection research priorities through patient engagement. Using a collaborative patient-centered feedback model, our Genomic Medicine Working Group identified related research priorities that could be investigated by pragmatic interventional studies aimed at aortic dissection prevention, utilization of genomic information to improve patient outcomes, and access to genomic medicine services. Further research is also needed to identify the genomic, lifestyle, and environmental risk factors that contribute to aortic dissection so these data can be incorporated into future comparative effectiveness studies to prevent aortic dissection.