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Crossnohere NL, Fischer R, Vroom E, Furlong P, Bridges JFP. A Comparison of Caregiver and Patient Preferences for Treating Duchenne Muscular Dystrophy. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:577-588. [PMID: 35243571 PMCID: PMC8894129 DOI: 10.1007/s40271-022-00574-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives Caregivers routinely inform medical and regulatory decision making in rare pediatric diseases. While differences in treatment preferences across caregivers and patients have been observed for Duchenne muscular dystrophy, this evidence was limited by small samples of patients and results were confounded by patient age and disease progression. We tested caregiver and patient preference concordance for treating Duchenne. Methods Preferences and demographic/clinical information from 115 caregivers and 107 patients were collected in an international study (response = 80%) using a previously developed discrete-choice experiment consisting of 12 experimentally controlled choice tasks. Each task presented two profiles that varied across four attributes: disease progression, drug failure probability, kidney damage risk, and fracture risk. Caregivers and patients were matched 1:1 based on patient age. We tested for concordance across each task and by comparing caregivers’ and patients’ maximum acceptable risk of drug failure, kidney damage, and fracture for a slowing of disease progression. Results The final analysis included 77 caregivers and 77 patients. No differences were observed in nationality (p = 0.969), disease stage (p = 0.180), or demographic/clinical factors (p = 0.093–0.857); however, patients were more optimistic (p = 0.030). Caregivers and patients chose similarly across tasks (p = 0.101–0.993). To slow disease progression by 1 year, caregivers and patients would tolerate a 9% and 11% increase in drug failure probability, respectively (p = 0.267). Alternatively, they would accept a 3% and 4% increase in the risk of kidney damage (p = 0.719) or a 15% and 20% increase in the risk of fracture (p = 0.534). Conclusions Caregivers and patients had concordant preferences for treating Duchenne. Providers and regulators can trust both caregiver and patient report of preferences to inform medical decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-022-00574-y.
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Vyas K, Luedke H, Ruban-Fell B. Nordic treatment guidelines for rare epileptic conditions: A literature review. Brain Behav 2022; 12:e2622. [PMID: 35765698 PMCID: PMC9304844 DOI: 10.1002/brb3.2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/09/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The onset of severe, drug-resistant seizures in early childhood is characteristic of the rare epileptic disorders Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and CDKL5 deficiency disorder (CDD) and is frequently observed in the rare genetic conditions tuberous sclerosis complex (TSC) and Rett syndrome (RTT). High-quality treatment guidelines are needed for optimal management of these conditions. This review aimed to assess content, availability, and development of treatment guidelines for these disorders in the Nordics region (Denmark, Finland, Iceland, Norway, and Sweden). METHODS A targeted literature review (TLR) was therefore conducted in November/December 2020 by manually searching online rare disease and guideline databases in addition to relevant health technology assessment and regulatory agency websites to identify pharmacological treatment guidelines for DS, LGS, TSC, RTT, and CDD. Search terms for each disorder were translated to identify country-specific guidelines. Treatment recommendations, geographical focus, and guideline development methodology was extracted into a predetermined extraction grid. RESULTS Most of the 24 eligible guidelines identified (16/24; 66%) were specific to particular countries; Sweden was the most represented (7/24 [29%] guidelines), while no guidelines were identified for Iceland. Guideline development methodologies were heterogeneous, including systematic literature reviews/TLRs and expert consultation; several methodologies did not report details on the evidence sources used (7/24 [29%] guidelines). Treatment recommendation availability was variable across disorders, ranging from 126 treatment recommendations (LGS) to none (RTT, CDD). CONCLUSION Comprehensive, consensus-based treatment guidance developed via international collaboration within the Nordics region is necessary to optimize patient care in these five rare epileptic conditions.
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Affiliation(s)
- Kishan Vyas
- GW Pharmaceuticals (A Jazz Pharmaceuticals company), London, UK
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Dammann P, Abla AA, Al-Shahi Salman R, Andrade-Barazarte H, Benes V, Cenzato M, Connolly ES, Cornelius JF, Couldwell WT, Sola RG, Gomez-Paz S, Hauck E, Hernesniemi J, Kivelev J, Lanzino G, Macdonald RL, Morcos JJ, Ogilvy CS, Steiger HJ, Steinberg GK, Santos AN, Rauschenbach L, Darkwah Oppong M, Schmidt B, Spetzler RF, Schaller K, Lawton MT, Sure U. Surgical treatment of brainstem cavernous malformations: an international Delphi consensus. J Neurosurg 2022; 136:1220-1230. [PMID: 34598135 DOI: 10.3171/2021.3.jns2156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Indication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM. METHODS A total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM. RESULTS Twenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery-, and BSCM-related aspects (22/37, 59%); and 4) clinical situation-based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios. CONCLUSIONS A summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.
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Affiliation(s)
- Philipp Dammann
- 1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany
| | - Adib A Abla
- 9Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Hugo Andrade-Barazarte
- 5Department of Neurosurgery, Juha Hernesniemi International Center, Henan Provincial People's Hospital, University of Zhengzhou, China
| | - Vladimir Benes
- 13Department of Neurosurgery and Neuro-oncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic
| | - Marco Cenzato
- 20Department of Neurosurgery, Niguarda Metropolitan Hospital, Milan, Italy
| | - E Sander Connolly
- 3Columbia University Medical Center Department of Neurological Surgery, New York, New York
| | - Jan F Cornelius
- 16Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Rafael G Sola
- 2UAM Chair "Innovation in Neurosurgery," Universidad Autónoma de Madrid, Spain
| | - Santiago Gomez-Paz
- 10Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Erik Hauck
- 17Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Juha Hernesniemi
- 5Department of Neurosurgery, Juha Hernesniemi International Center, Henan Provincial People's Hospital, University of Zhengzhou, China
| | - Juri Kivelev
- 4Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | | | - R Loch Macdonald
- 8Department of Neurological Surgery, University of California, San Francisco, Fresno Campus, Fresno, California
| | - Jacques J Morcos
- 12Department of Neurological Surgery, University of Miami, Florida
| | - Christopher S Ogilvy
- 10Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hans-Jakob Steiger
- 16Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gary K Steinberg
- 7Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
| | - Alejandro N Santos
- 1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany
| | - Laurèl Rauschenbach
- 1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany
| | | | - Börge Schmidt
- 19Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Robert F Spetzler
- 6Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Karl Schaller
- 18Department of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | - Michael T Lawton
- 6Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ulrich Sure
- 1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany
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Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Grant S, Armstrong C, Khodyakov D. Online Modified-Delphi: a Potential Method for Continuous Patient Engagement Across Stages of Clinical Practice Guideline Development. J Gen Intern Med 2021; 36:1746-1750. [PMID: 33742303 PMCID: PMC8175513 DOI: 10.1007/s11606-020-06514-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN USA
- RAND Health Care, RAND Corporation, Santa Monica, CA USA
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Smith J, Damm K, Hover G, Chien J. Lessons from an Experiential Approach to Patient Community Engagement in Rare Disease. Clin Ther 2020; 43:421-429. [PMID: 33375998 DOI: 10.1016/j.clinthera.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 01/09/2023]
Abstract
Meaningful engagement between biopharmaceutical companies and patient communities has increasingly become an important part of the therapeutic-development process, as such engagement improves the understanding of the multifaceted challenges and unmet needs that communities experience and provides an opportunity to inform the approach to the development of new therapies and services. Presented here are learnings from a community-advisor program designed to engage families of patients with Duchenne muscular dystrophy (DMD) in a manner that enabled caregivers to make valuable contributions to the therapeutic-development process and to the DMD community. Parents of children with DMD, representing the broader DMD community, were identified in partnership with patient-advocacy organizations and invited to participate in a community-advisor meeting with members of Wave Life Sciences. The community-advisor meeting was designed to provide participants with an opportunity to share their personal experiences with DMD, to help to inform the therapeutic-development process, and to identify potential solutions for addressing unmet needs. Three community-advisor meetings were held with a total of 30 parents, representing 36 children with DMD. Key themes that emerged from the advisors' discussion included the importance of the community's emotional and mental support, the inconsistencies in DMD care, the increased challenges and disparities faced by underserved communities, and the need for more comprehensive, holistic approaches to the treatment and management of DMD. The advisors viewed the meetings as an opportunity to share their voices with a biopharmaceutical company, coupled with the advantage of meeting other families living with similar challenges. Most of the advisors stated that this was their first advisor meeting. This community-focused approach empowered participants to voice their needs and perspectives, to brainstorm potential solutions for addressing those needs, and to initiate and foster connections in ways that had a considerable impact on one another and on therapeutic-development programs at Wave Life Sciences.
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Affiliation(s)
| | - Kelly Damm
- Wave Life Sciences USA Inc, Cambridge, MA, USA
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8
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Zia A, Kouides P, Khodyakov D, Dao E, Lavin M, Kadir RA, Othman M, Bauman D, Halimeh S, Winikoff R, Revel-Vilk S. Standardizing care to manage bleeding disorders in adolescents with heavy menses-A joint project from the ISTH pediatric/neonatal and women's health SSCs. J Thromb Haemost 2020; 18:2759-2774. [PMID: 32573942 DOI: 10.1111/jth.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bleeding disorders (BD) are under-recognized in adolescents with heavy menstrual bleeding (HMB). OBJECTIVES The lack of clinical guidelines and variable symptomatic management of HMB created the imperative to standardize HMB care to identify and manage BD in adolescents. METHODS We convened an international working group (WG), utilized the results of a literature review to define knowledge gaps in HMB care, and used the collective clinical experience of the WG to develop care considerations for adolescents with BD and HMB. We then solicited input on the appropriateness of HMB care considerations from expert stakeholders representing hematology, adolescent medicine, and obstetrics-gynecology. We conducted an expert panel online, using the ExpertLens platform. During a three-round online modified-Delphi process, the expert panel rated the appropriateness of 21 care considerations using a 9-point scale to designate care as appropriate (7-9), uncertain (4-6), or inappropriate (1-3) covering screening for BD, the laboratory work-up, and management of adolescents with BD that present with HMB. We used the RAND/UCLA appropriateness method to determine the existence of consensus among the interdisciplinary panel of experts. RESULTS Thirty-nine experts participated in the panel. The experts rated fifteen HMB care considerations as appropriate, six as uncertain, and none as inappropriate. CONCLUSIONS The HMB care statements represent the first set of HMB care considerations in adolescents with BD, developed with broad expert input on appropriateness. Although likely to be of interest to a range of clinicians who routinely manage adolescents with HMB, additional research is required in many key areas.
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Affiliation(s)
- Ayesha Zia
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Pediatric Hematology Oncology, Children's Health, Dallas, TX, USA
| | - Peter Kouides
- The University of Rochester and the Mary M. Gooley Hemophilia Treatment Center, Rochester, NY, USA
| | | | - Emily Dao
- RAND Corporation, Santa Monica, CA, USA
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rezan Abdul Kadir
- The Royal Free Foundation Hospital and Institute for Women's Health, University College, London, UK
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University Kingston, School of Baccalaureate Nursing, St Lawrence College Kingston, Kingston, ON, Canada
| | - Dvora Bauman
- Department of Pediatric and Adolescent Gynecology, Hadassah University Medical Center, Jerusalem, Israel
| | - Susan Halimeh
- Medical Thrombosis and Haemophilia Treatment Center, Duisburg, Germany
| | - Rochelle Winikoff
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montréal, Canada
| | - Shoshana Revel-Vilk
- Pediatric Hematology/Oncology Unit, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
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Khodyakov D, Grant S, Denger B, Kinnett K, Martin A, Peay H, Coulter I. Practical Considerations in Using Online Modified-Delphi Approaches to Engage Patients and Other Stakeholders in Clinical Practice Guideline Development. THE PATIENT 2020; 13:11-21. [PMID: 31544219 PMCID: PMC6957573 DOI: 10.1007/s40271-019-00389-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients and caregivers are increasingly recognized as key stakeholders in developing clinical practice guidelines (CPGs). Online engagement approaches offer the promise of a rigorous, scalable, and convenient engagement method. This paper illustrates how an online modified-Delphi approach could be used to engage patients, caregivers, and other stakeholder in CPG development. It provides practical guidance for conducting online modified-Delphi panels that covers (1) joint development of the engagement approach with relevant stakeholders, (2) adaptation of methods used by experts in guideline development, (3) pilot testing, (4) participant recruitment, (5) determining panel size and composition, (6) building participant capacity, (7) facilitation of two-way interaction, (8) continuous engagement and retention of participants, (9) rigorous data analysis, (10) evaluation of engagement activities, and (11) result dissemination. The paper is based on a recently completed study about engaging individuals with Duchenne muscular dystrophy (DMD) and their caregivers in determining the patient-centeredness of DMD care guidelines.
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Affiliation(s)
- Dmitry Khodyakov
- RAND Health Care, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA USA
| | - Sean Grant
- RAND Health Care, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA USA
- Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN USA
| | - Brian Denger
- Parent Project Muscular Dystrophy, Hackensack, NJ USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, NJ USA
| | - Ann Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ USA
| | - Holly Peay
- RTI International, Research Triangle Park, NC USA
| | - Ian Coulter
- RAND Health Care, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA USA
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10
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Khodyakov D, Grant S, Denger B, Kinnett K, Martin A, Booth M, Armstrong C, Dao E, Chen C, Coulter I, Peay H, Hazlewood G, Street N. Using an Online, Modified Delphi Approach to Engage Patients and Caregivers in Determining the Patient-Centeredness of Duchenne Muscular Dystrophy Care Considerations. Med Decis Making 2019; 39:1019-1031. [PMID: 31722623 PMCID: PMC6900571 DOI: 10.1177/0272989x19883631] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/21/2019] [Indexed: 12/30/2022]
Abstract
Purpose. To determine the patient-centeredness of endocrine and bone health Duchenne muscular dystrophy (DMD) care considerations using the RAND/PPMD Patient-Centeredness Method (RPM), which is a novel, online, modified-Delphi approach to engaging patients and caregivers in clinical guideline development. Methods. We solicited input on the patient-centeredness of care considerations from 28 individuals with DMD and 94 caregivers, randomly assigned to 1 of 2 mixed panels. During a 3-round online modified-Delphi process, participants rated the importance and acceptability of 19 DMD care considerations (round 1), reviewed and discussed the initial results (round 2), and revised their original ratings (round 3). Patient-centeredness was operationalized as importance and acceptability of recommendations. We considered a care consideration to be patient-centered if both panels deemed it important and acceptable. Results. Ninety-five panelists (78%) participated in this study. Of these, 88 (93%) participated in round 1, 74 (78%) in round 2, and 56 (59%) in round 3. Panelists deemed 12 care considerations to be patient-centered: 3 weight management, 3 bone health, 4 vertical growth, and 2 puberty recommendations. Seven care considerations did not meet patient-centeredness criteria. Common reasons were lack of evidence specific to DMD and concerns about insurance coverage, access to treatment, and patient safety. Conclusions. Using the RPM, Duchenne families considered most care considerations to be patient-centered. Besides being clinically appropriate, these considerations are likely to be consistent with the preferences, needs, and values of Duchenne families. While all relevant care considerations should be discussed during patient-provider encounters, those that did not meet patient-centeredness criteria in particular should be carefully considered as part of joint decision making between Duchenne families and their providers. Study Registration: HSRProj 20163126.
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Affiliation(s)
| | - Sean Grant
- />RAND Health Care, Santa Monica, CA, USA
- />Department of Social & Behavioral Sciences,
Indiana University Richard M. Fairbanks School of Public Health,
Indianapolis, IN, USA
| | - Brian Denger
- Parent Project Muscular Dystrophy, Hackensack,
NJ, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack,
NJ, USA
| | - Ann Martin
- Parent Project Muscular Dystrophy, Hackensack,
NJ, USA
| | | | | | | | | | | | - Holly Peay
- RTI International, Research Triangle Park, NC,
USA
| | - Glen Hazlewood
- Department of Medicine, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
| | - Natalie Street
- Centers for Disease Control and Prevention,
National Center on Birth Defects and Developmental Disabilities, Atlanta,
GA, USA
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11
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Denger B, Kinnett K, Martin A, Grant S, Armstrong C, Khodyakov D. Patient and caregiver perspectives on guideline adherence: the case of endocrine and bone health recommendations for Duchenne muscular dystrophy. Orphanet J Rare Dis 2019; 14:205. [PMID: 31429780 PMCID: PMC6702715 DOI: 10.1186/s13023-019-1173-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical care guidelines are typically developed by clinicians and researchers. Including patient and caregiver voices in guideline development may help create guidelines that are more useful for patients and consequently improve their guideline adherence. Although there is substantial research on the factors the affect providers' adherence to guidelines, there is less research on the factors that affect patients' compliance with guideline recommendations, especially among those with rare disorders. The purpose of this study is to explore factors that are likely to affect patient/caregiver adherence to endocrine and bone health recommendations for Duchenne Muscular Dystrophy (DMD). To do so, we used qualitative data collected as part of the study designed to develop, implement, and evaluate a new online, modified-Delphi approach to engaging patients with rare diseases and their caregivers in guideline development, using care guidelines for DMD as a case study. METHODS We thematically analyzed qualitative data collected from 95 adults with DMD and their caregivers who participated in at least one round of our online Modified-Delphi panel process. Participants rated and commented on the patient-centeredness of 19 recommendations about vertical growth, weight management, bone health, and delayed puberty included in the 2018 DMD care considerations. Patient-centeredness was operationalized as the importance and acceptability of care recommendations. RESULTS Thematic analyses revealed six factors that affect guideline adherence from the patient/caregiver perspective: content and format of recommendations, patient and provider characteristics, and social and financial factors. CONCLUSIONS This study used a novel approach to exploring patient and caregiver perspectives on factors that may affect guideline adherence. The six factors identified by DMD patients and caregivers are similar to the factors affecting provider adherence and are not limited to DMD. Understanding consistency between provider- and patient/caregiver-identified barriers to following guideline recommendations can lead to developing more successful interventions for increasing guideline adherence.
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Affiliation(s)
- Brian Denger
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Ann Martin
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Sean Grant
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.,Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, 46202, IN, USA
| | - Courtney Armstrong
- RAND Corporation, 1885 Mission Street, Suite 300, San Francisco, CA, 94103, USA
| | - Dmitry Khodyakov
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
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12
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Armstrong C, Grant S, Kinnett K, Denger B, Martin A, Coulter I, Booth M, Khodyakov D. Participant experiences with a new online modified-Delphi approach for engaging patients and caregivers in developing clinical guidelines. EUROPEAN JOURNAL FOR PERSON CENTERED HEALTHCARE 2019; 7:476-489. [PMID: 34422276 PMCID: PMC8375559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND Patient engagement in clinical practice guideline (CPG) development has increased significantly in recent years. However, only a few patients and caregivers join CPG development groups. OBJECTIVE To describe participant experiences with a novel online, scalable approach for patient and caregiver engagement in CPG development. DESIGN We developed and tested the RAND/PPMD Patient-Centeredness Method (RPM), a novel online modified-Delphi approach to patient engagement in CPG development that consists of an optional idea generation round and two rating rounds interspersed with an online discussion round. SETTING AND PARTICIPANTS Using the online ExpertLens™ system, we ran 2 concurrent panels of patients and caregivers of individuals with Duchenne Muscular Dystrophy (DMD). MAIN OUTCOME MEASURES We surveyed all 95 panel participants about their participation and satisfaction with the process. We also conducted telephone interviews with 25 participants. RESULTS Participants expressed satisfaction with various ExpertLens™ features, noting that the system fostered lively interaction among them. Panelists also appreciated participating in an educational, interactive and convenient discussion forum that allowed them to share their opinions on the importance and acceptability of different recommendations. The RPM was viewed as empowering by patients and their caregivers who felt it would be useful for CPG developers. DISCUSSION AND CONCLUSION The results of our study show the overall participant satisfaction with a novel, scalable, online approach to engaging patients and caregivers in CPG development, which allows them to share their perspectives and lived experiences using a rigorous, systematic and iterative way that is similar to how clinicians provide their input.
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Affiliation(s)
- Courtney Armstrong
- Policy Analyst, RAND Health Care, RAND Corporation, San Francisco, CA, USA
| | - Sean Grant
- Assistant Professor, Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA; Adjunct Behavioral/Social Scientist, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Kathi Kinnett
- Senior Vice President, Clinical Care, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Brian Denger
- Collaborative Programs Administrator, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Ann Martin
- Director, The Duchenne Registry, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Ian Coulter
- Policy Researcher, Adjunct, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Marika Booth
- Statistical Analyst, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Dmitry Khodyakov
- Senior Behavioral/Social Scientist, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
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13
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Khodyakov D, Denger B, Grant S, Kinnett K, Armstrong C, Martin A, Peay H, Coulter I, Hazlewood G. The RAND/PPMD Patient-Centeredness Method: a novel online approach to engaging patients and their representatives in guideline development. EUROPEAN JOURNAL FOR PERSON CENTERED HEALTHCARE 2019; 7:470-475. [PMID: 34277012 PMCID: PMC8281319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Although clinical practice guidelines (CPGs) provide recommendations for how best to treat a typical patient with a given condition, patients and their representatives are not always engaged in CPG development. Despite the agreement that patient participation may improve the quality and utility of CPGs, there is no systematic, scalable method for engaging patients and their representatives, as well as no consensus on what exactly patients and their representatives should be asked to do during CPG development. To address these gaps, an interdisciplinary team of researchers, patient representatives, and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a novel online approach to engaging patients and their representatives in CPG development. The RPM is an iterative approach that allows patients and their representatives to provide input by (1) generating ideas; (2) rating draft recommendations on two criteria (importance and acceptability); (3) explaining and discussing their ratings with other participants using online, asynchronous, anonymous, moderated discussion boards, and (4) revising their responses if needed. The RPM was designed to be consistent with the RAND/UCLA Appropriateness Method used by clinicians and researchers to develop CPG, while helping patients and their representative rate outcome importance and recommendation acceptability - two key components of the GRADE Evidence to Decision (EtD) framework. With slight modifications, the RPM has the potential to explore consensus among key stakeholders on other dimensions of the EtD, including feasibility, equity, and resource use.
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Affiliation(s)
- Dmitry Khodyakov
- Senior Behavioral/Social Scientist, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Brian Denger
- Collaborative Programs Administrator, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Sean Grant
- Assistant Professor, Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN & Adjunct Behavioral/Social Scientist, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Kathi Kinnett
- Senior Vice President, Clinical Care, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Courtney Armstrong
- Policy Analyst, RAND Health Care, RAND Corporation, San Francisco, CA, USA
| | - Ann Martin
- Director, The Duchenne Registry, Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Holly Peay
- Senior Research Public Health Analyst, RTI International, Raleigh, NC, USA
| | - Ian Coulter
- Policy Researcher, Adjunct, RAND Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Glen Hazlewood
- Assistant Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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14
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Grant S, Hazlewood GS, Peay HL, Lucas A, Coulter I, Fink A, Khodyakov D. Practical Considerations for Using Online Methods to Engage Patients in Guideline Development. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:155-166. [PMID: 29030831 DOI: 10.1007/s40271-017-0280-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Clinical practice guidelines (CPGs) have been widely used in healthcare policy, practice, and for suggesting future research. As patients increasingly become involved in CPG development to produce patient-centered recommendations, more research is needed on methods to engage patients, particularly methods allowing for scalable engagement of large, diverse, and geographically distributed groups of patients. In this article, we discuss practical considerations for using online methods to engage patients in CPG development. To inform this discussion, we conducted a rapid, systematic review of literature on patient involvement in CPG development and used qualitative evidence synthesis techniques to make inferences about potential advantages and challenges of using online methods to engage patients in this context. We identified 79 articles containing information about involving patients in CPG development. Potential advantages include the ability of online methods to facilitate greater openness and honesty by patients, as well as to reflect the diversity of patient views, which in turn further improve the utility of CPGs. Potential challenges of using online methods may include the extra skill, time, and certain types of resources that may be needed for patient engagement, as well as the difficulty engaging specific patient populations. However, these challenges are mitigated by growing calls for patient engagement as normative for CPG development in addition to patients' increasing familiarity with online technologies. These practical considerations should be examined empirically as guideline development groups further explore the appropriateness of using online methods to engage patients across different stages of CPG development.
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Affiliation(s)
- Sean Grant
- Behavioral and Policy Sciences Department, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Holly L Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ann Lucas
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Ian Coulter
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, CA, USA
| | - Arlene Fink
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Dmitry Khodyakov
- Behavioral and Policy Sciences Department, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Young A, Menon D, Street J, Al-Hertani W, Stafinski T. Exploring patient and family involvement in the lifecycle of an orphan drug: a scoping review. Orphanet J Rare Dis 2017; 12:188. [PMID: 29273068 PMCID: PMC5741909 DOI: 10.1186/s13023-017-0738-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i.e., orphan drug lifecycle). METHODS A scoping review was conducted using methods outlined by Arksey and O'Malley. To validate the findings from the literature and identify any additional opportunities that were missed, a consultative webinar was conducted with members of the Patient and Caregiver Liaison Group of a Canadian research network. RESULTS Existing and proposed opportunities for involving patients, families, and patient organizations were reported throughout the orphan drug lifecycle and fell into 12 themes: research outside of clinical trials; clinical trials; patient reported outcomes measures; patient registries and biorepositories; education; advocacy and awareness; conferences and workshops; patient care and support; patient organization development; regulatory decision-making; and reimbursement decision-making. Existing opportunities were not described in sufficient detail to allow for the level of involvement to be assessed. Additionally, no information on the impact of involvement within specific opportunities was found. Based on feedback from patients and families, documentation of existing opportunities within Canada is poor. CONCLUSIONS Opportunities for patient, family, and patient organization involvement exist throughout the orphan drug lifecycle. However, based on the information found, it is not possible to determine which opportunities would be most effective at each stage.
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Affiliation(s)
- Andrea Young
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Jackie Street
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Walla Al-Hertani
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
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