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Cazzolli R, Sluiter A, Bateman S, Candler H, Cho Y, Cooper T, Craig JC, Dominello A, Duncanson E, Guha C, Hawley CM, Hewawasam E, Hickey L, Hill K, Howard K, Howell M, Huuskes BM, Irish GL, Jesudason S, Johnson DW, Kelly A, Leary D, Manera K, Mazis J, McDonald S, McLennan H, Muthuramalingam S, Pummeroy M, Scholes-Robertson N, Teixeira-Pinto A, Tunnicliffe DJ, van Zwieten A, Viecelli AK, Wong G, Jaure A. Improving Diverse and Equitable Involvement of Patients and Caregivers in Research in CKD: Report of a Better Evidence and Translation - Chronic Kidney Disease (BEAT-CKD) Workshop. Am J Kidney Dis 2024:S0272-6386(24)00784-4. [PMID: 38810688 DOI: 10.1053/j.ajkd.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 05/31/2024]
Abstract
Patient and caregiver involvement can enhance the uptake and impact of research, however, the involvement of patients and caregivers who are underserved and marginalized is often limited. A better understanding of how to make involvement in research more broadly accessible, supportive, and inclusive for patients with CKD and caregivers is needed. We conducted a national workshop involving patients, caregivers, clinicians and researchers across Australia to identify strategies to increase the diversity of patients and caregivers involved in CKD research. Six themes were identified. Building trust and a sense of safety was considered pivotal to establishing meaningful relationships to support knowledge exchange. Establishing community and connectedness was expected to generate a sense of belonging to motivate involvement. Balancing stakeholder goals, expectations and responsibilities involved demonstrating commitment and transparency by researchers. Providing adequate resources andsupport included strategies to minimize the burden of involvement for patients and caregivers. Making research accessible and relatable was about nurturing patient and caregiver interest by appealing to intrinsic motivators. Adapting to patient and caregiver needs and preferences required tailoring the approach for individuals and the target community. Strategies and actions to support these themes may support more diverse and equitable involvement of patients and caregivers in research in CKD.
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Affiliation(s)
- Rosanna Cazzolli
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Amanda Sluiter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Samantha Bateman
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Hayley Candler
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tess Cooper
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amanda Dominello
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Chandana Guha
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Erandi Hewawasam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Laura Hickey
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kathy Hill
- University of South Australia, Adelaide, South Australia, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia
| | - Brooke M Huuskes
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture. Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - Georgina L Irish
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David W Johnson
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Diana Leary
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Karine Manera
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jasmin Mazis
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen McDonald
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Helen McLennan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Shyamsundar Muthuramalingam
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea K Viecelli
- Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Munce SEP, Wong E, Luong D, Rao J, Cunningham J, Bailey K, John T, Barber C, Batthish M, Chambers K, Cleverley K, Crabtree M, Diaz S, Dimitropoulos G, Gorter JW, Grahovac D, Grimes R, Guttman B, Hébert ML, Henze M, Higgins A, Khodyakov D, Li E, Lo L, Macgregor L, Mooney S, Severino SM, Mukerji G, Penner M, Pidduck J, Shulman R, Stromquist L, Trbovich P, Wan M, Williams L, Yates D, Toulany A. Patient, caregiver and other knowledge user engagement in consensus-building healthcare initiatives: a scoping review protocol. BMJ Open 2024; 14:e080822. [PMID: 38719333 PMCID: PMC11086512 DOI: 10.1136/bmjopen-2023-080822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Patient engagement and integrated knowledge translation (iKT) processes improve health outcomes and care experiences through meaningful partnerships in consensus-building initiatives and research. Consensus-building is essential for engaging a diverse group of experienced knowledge users in co-developing and supporting a solution where none readily exists or is less optimal. Patients and caregivers provide invaluable insights for building consensus in decision-making around healthcare, policy and research. However, despite emerging evidence, patient engagement remains sparse within consensus-building initiatives. Specifically, our research has identified a lack of opportunity for youth living with chronic health conditions and their caregivers to participate in developing consensus on indicators/benchmarks for transition into adult care. To bridge this gap and inform our consensus-building approach with youth/caregivers, this scoping review will synthesise the extent of the literature on patient and other knowledge user engagement in consensus-building healthcare initiatives. METHODS AND ANALYSIS Following the scoping review methodology from Joanna Briggs Institute, published literature will be searched in MEDLINE, EMBASE, CINAHL and PsycINFO databases from inception to July 2023. Grey literature will be hand-searched. Two independent reviewers will determine the eligibility of articles in a two-stage process, with disagreements resolved by a third reviewer. Included studies must be consensus-building studies within the healthcare context that involve patient engagement strategies. Data from eligible studies will be extracted and charted on a standardised form. Abstracted data will be analysed quantitatively and descriptively, according to specific consensus methodologies, and patient engagement models and/or strategies. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. Dissemination of findings will also include peer-reviewed publications and conference presentations. The results will offer new insights for supporting patient engagement in consensus-building healthcare initiatives. PROTOCOL REGISTRATION https://osf.io/beqjr.
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Affiliation(s)
- Sarah E P Munce
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elliott Wong
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dorothy Luong
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Justin Rao
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Bailey
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Tomisin John
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Barber
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Kyle Chambers
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health Queen Street Site, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Crabtree
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Sanober Diaz
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Southern Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Danijela Grahovac
- National Health Hub in Transition, Children's Healthcare Canada, Hamilton, Southern Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Southern Ontario, Canada
| | - Ruth Grimes
- Canadian Pediatric Society, Winnipeg, Manitoba, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Michèle L Hébert
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Henze
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Surrey Place Centre, Toronto, Ontario, Canada
| | - Amanda Higgins
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Elaine Li
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Lisha Lo
- University of Toronto Centre for Quality Improvement and Patient Safety, Toronto, Ontario, Canada
| | - Laura Macgregor
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Martin Luther University College, Waterloo, Ontario, Canada
| | - Sarah Mooney
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Samadhi Mora Severino
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Melanie Penner
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jacklynn Pidduck
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Rayzel Shulman
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Endocrinology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Stromquist
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- National Health Hub in Transition, Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - Patricia Trbovich
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Patient Safety and Quality Improvement, North York General Hospital, Toronto, Ontario, Canada
| | - Michelle Wan
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Laura Williams
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Darryl Yates
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Alene Toulany
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Rao S, Dimitropoulos G, Jardine R, Quickstad J, Satam L, Qureshi M, Bui T, Todorova AA, Tumaneng Y, Suthakaran A, Dalley K, Smith S, Patten SB. Primus Inter PARES: First among equals-practical strategies for young adult PAtient RESearch partners (PARES) by young adult PARES. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:45. [PMID: 38720386 PMCID: PMC11077772 DOI: 10.1186/s40900-024-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. MAIN BODY The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. CONCLUSION This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada.
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Rae Jardine
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Julien Quickstad
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Laetitia Satam
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Mohammad Qureshi
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Thyra Bui
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Antoaneta Alexandrova Todorova
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ysabelle Tumaneng
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Abitha Suthakaran
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Kaiden Dalley
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Stacie Smith
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Karlsson AW, Kragh-Sørensen A, Børgesen K, Behrens KE, Andersen T, Maglekær KM, Rothmann MJ, Ketelaar M, Petersen EN, Janssens A. Wider institutional research cultures and their influence on patient and public involvement and engagement in health research - An institutional ethnography. Soc Sci Med 2024; 347:116773. [PMID: 38513563 DOI: 10.1016/j.socscimed.2024.116773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Focus on patient and public involvement and engagement (PPIE) is increasing in health policy and research governance. PPIE is considered by some to be a democratic right, and by others to be a way to improve health care and research outcomes and implementation. Most recently, policy makers, funders and (clinical) research institutions are making PPIE a strategic requirement for health research urging researchers to invite patients and relatives into their research activities. Our study is based in a Danish university hospital where PPIE has been introduced as one of five strategic research goals. We investigated how researchers experienced this new practice and how their research practices connect to the wider context of the Danish health care system. Ten cases were studied during a year using observations, interviews, and document analysis. As our method of inquiry, we used institutional ethnography to look at researchers' work from their perspective and to understand how PPIE practices are part of a larger institutional research culture reaching far beyond the individual. We found that current research culture has implications for the selection of patients and relatives and for what they are asked to do. Researchers who experienced that PPIE outcomes aided their existing research practices felt motivated. Researchers who engaged patients and relatives before it was a strategy, were ideologically driven and their approaches resulted in an increased diversity of inclusion and researcher assimilation. These findings add to the current knowledge on PPIE practices and help us understand that further development towards collaborative research practices require a change in key performance indicators and training and perhaps call for attention to our shared acceptance of knowledge generation in research.
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Affiliation(s)
- Anne Wettergren Karlsson
- Department of Public Health, University of Southern Denmark. Centre for Research with Patients and Relatives, Odense University Hospital, Denmark.
| | | | - Kirsten Børgesen
- Department of Public Health, University of Southern Denmark, Denmark
| | | | - Torben Andersen
- Department of Public Health, University of Southern Denmark, Denmark
| | | | - Mette Juel Rothmann
- Steno Diabetes Centre, Odense University Hospital, Denmark; Centre of Medical Innovation and Technology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Marjolijn Ketelaar
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Esben Nedenskov Petersen
- Department of Media, Design, Education and Cognition and Department of Public Health, University of Southern Denmark, Denmark
| | - Astrid Janssens
- Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Department of Public Health, University of Southern Denmark. Centre for Research with Patients and Relatives, Odense University Hospital, Denmark; University of Exeter Medical School, UK
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Nguyen L, Pozniak K, Strohm S, Havens J, Dawe-McCord C, Thomson D, Putterman C, Arafeh D, Galuppi B, Ley AVD, Doucet S, Amaria K, Kovacs AH, Marelli A, Rozenblum R, Gorter JW. Navigating meaningful engagement: lessons from partnering with youth and families in brain-based disability research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:17. [PMID: 38317213 PMCID: PMC10845676 DOI: 10.1186/s40900-024-00543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND While patient and family engagement in research has become a widespread practice, meaningful and authentic engagement remains a challenge. In the READYorNot™ Brain-Based Disabilities Study, we developed the MyREADY Transition™ Brain-Based Disabilities App to promote education, empowerment, and navigation for the transition from pediatric to adult care among youth with brain-based disabilities, aged 15-17 years old. Our research team created a Patient and Family Advisory Council (PFAC) to engage adolescents, young adults, and parent caregivers as partners throughout our multi-year and multi-stage project. MAIN BODY This commentary, initiated and co-authored by members of our PFAC, researchers, staff, and a trainee, describes how we corrected the course of our partnership in response to critical feedback from partners. We begin by highlighting an email testimonial from a young adult PFAC member, which constituted a "critical turning point," that unveiled feelings of unclear expectations, lack of appreciation, and imbalanced relationships among PFAC members. As a team, we reflected on our partnership experiences and reviewed documentation of PFAC activities. This process allowed us to set three intentions to create a collective goal of authentic and meaningful engagement and to chart the course to get us there: (1) offering clarity and flexibility around participation; (2) valuing and acknowledging partners and their contributions; and (3) providing choice and leveraging individual interests and strengths. Our key recommendations include: (1) charting the course with a plan to guide our work; (2) learning the ropes by developing capacity for patient-oriented research; (3) all hands on deck by building a community of engagement; and (4) making course corrections and being prepared to weather the storms by remaining open to reflection, re-evaluation, and adjustment as necessary. CONCLUSIONS We share key recommendations and lessons learned from our experiences alongside examples from the literature to offer guidance for multi-stage research projects partnering with adolescents, young adults, and family partners. We hope that by sharing challenges and lessons learned, we can help advance patient and family engagement in research.
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Affiliation(s)
- Linda Nguyen
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
| | - Kinga Pozniak
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Sonya Strohm
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Jessica Havens
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Claire Dawe-McCord
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Donna Thomson
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Connie Putterman
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Dana Arafeh
- Patient and Family Advisory Council, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Barb Galuppi
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Alicia Via-Dufresne Ley
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - Shelley Doucet
- Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Khush Amaria
- CBT Associates (A CloudMD Company), Toronto, ON, Canada
| | | | - Ariane Marelli
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ronen Rozenblum
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Brown R, Graham S, Girard J, Moulaison N. Patient Engagement in Provincial and Territorial Medical Association Decision-Making: A Rapid Scoping Review. Cureus 2024; 16:e54400. [PMID: 38505451 PMCID: PMC10948959 DOI: 10.7759/cureus.54400] [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] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
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.
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Affiliation(s)
- Ryan Brown
- Emergency Medicine, Dalhousie University, Halifax, CAN
- Health System Integration and Practice Support, Doctors Nova Scotia, Dartmouth, CAN
| | - Samantha Graham
- Policy and Physician Wellness, Doctors Nova Scotia, Dartmouth, CAN
| | - Jennifer Girard
- Health System Integration and Practice Support, Doctors Nova Scotia, Dartmouth, CAN
| | - Noelle Moulaison
- Health System Integration and Practice Support, Doctors Nova Scotia, Dartmouth, CAN
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Zaratin P, Khan U, Graffigna G. Comment on "Reflections on patient engagement by patient partners: How it can go wrong". RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:122. [PMID: 38129935 PMCID: PMC10740255 DOI: 10.1186/s40900-023-00534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
As patient-advocacy, public policy and clinical researchers with special knowledge on Responsible Research Innovation (RRI) governance and the public health and psychology underlying patient engagement, we read with interest the comment contribution by Richards et al., "Reflections on patient engagement by patient partners: How it can go wrong" (Richards et al. in Res Involv Engagem 9:41, 2023. https://doi.org/10.1186/s40900-023-00454-13 ). As a way to help meet the "take-away actions for readers" included by the authors at the end of the article, we would like to further stimulate discussion with relevant stakeholder communities about the need to rethink the use of "expert patient". Based on our experience, the lack of a governance model engaging patients who are representative of the target patient community, as opposed to expert patients, is at the root of the tokenistic approach, the "patient partner as a checkmark statement" and the "lack of recognizing the vulnerability of patient partners", which results in "patient engagement going wrong". According to our experience, the Responsible Research Innovation (RRI) MULTI-ACT model has the potential to help meet these challenges.
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Affiliation(s)
- Paola Zaratin
- Italian Multiple Sclerosis Society Foundation, Genoa, Italy.
| | - Usman Khan
- Institute for Health Care Policy, KU Louvain, Leuven, Belgium
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
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Blanchette V, Todkar S, Brousseau-Foley M, Rheault N, Weisz T, Poitras ME, Paquette JS, Tremblay MC, Costa IG, Dogba MJ, Giguere A, de Mestral C, Légaré F. Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review. Can J Diabetes 2023; 47:682-694.e17. [PMID: 37437841 DOI: 10.1016/j.jcjd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. METHODS We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care. RESULTS Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. CONCLUSIONS Very few studies described patients' characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly managed type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada.
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec, affiliated with Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Trois-Rivières, Canada
| | - Nathalie Rheault
- Québec SSA Support Unit, Sherbrooke University, Longueil Campus, Longueuil, Québec, Canada
| | - Tom Weisz
- Patient Partner, Diabetes Action Canada, Toronto General Hospital, Toronto, Ontario, Canada; Patient Partner, Wounds Canada, North York, Ontario, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Saguenay, Québec, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Idevânia G Costa
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada; Canada Research Chair in Shared Decision-Making and Knowledge Translation, Québec, Canada
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Marwaa MN, Guidetti S, Ytterberg C, Kristensen HK. Using experience-based co-design to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:69. [PMID: 37620982 PMCID: PMC10463694 DOI: 10.1186/s40900-023-00472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Abstract
AIM To investigate and describe the process of using experience-based co-design (EBCD) to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation. SETTING Two cross-sectoral stroke rehabilitation settings in Denmark comprising six rehabilitation units. PARTICIPANTS Stroke survivors (n = 23), significant others (n = 18), occupational therapists (n = 12), physiotherapists (n = 9), representative of a patient organization (n = 1), application developers (n = 3) and researchers (n = 2). METHOD A structured, facilitated EBCD approach comprising six stages was used to co-design a service that aimed to address the priorities and needs of all relevant end-users. Data were collected by interviews, participant observations, notes on "flip sheets" and written feedback on the content in the apps and on the instruction pages. Data were analyzed descriptively and with a constructivist grounded theory analysis. RESULTS The content in the application solutions "Mit Sygehus" and "Genoptræn.dk" were co-designed to support the needs identified by all end-users. Relevant evidence-based knowledge, person-centred exercises and guidelines using video recordings were the most important among the developed content in the applications to support person-centred and empowering stroke rehabilitation. Furthermore, easy, and seamless communication were considered important. CONCLUSIONS EBCD facilitated the development of content in the applications to support a person-centred and empowering stroke rehabilitation. Participants experienced that their contribution was considered important and valued.
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Affiliation(s)
- Mille Nabsen Marwaa
- Department of Physiotherapy Education, University College Southern Denmark, Esbjerg, Denmark.
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
- Center for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Susanne Guidetti
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
- Geriatric Research Unit, Department of Clinical Research University Hospital Odense, University of Southern Denmark, Odense, Denmark.
| | - Hanne Kaae Kristensen
- Center for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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