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Thavorn K, Thompson E, Kumar S, Heiskanen A, Agarwal A, Atkins H, Shorr R, Hawrysh T, Kar-Wing Chan K, Presseau J, Ollendorf DA, Graham ID, Grimshaw JM, Lalu MM, Nochaiwong S, Fergusson DA, Hutton B, Coyle D, Kekre N. Economic Evaluations of CAR-T Cell Therapies for Hematologic and Solid Malignancies: A Systematic Review. Value Health 2024:S1098-3015(24)02336-2. [PMID: 38641057 DOI: 10.1016/j.jval.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES This study aims to systematically review evidence on the cost-effectiveness of chimeric antigen receptor (CAR)-T therapies for patients with cancer. METHODS Electronic databases were searched in October 2022 and updated in September 2023. Systematic reviews, health technology assessments and economic evaluations that compared costs and effects of CAR-T therapy in cancer patients were included. Two reviewers independently screened studies, extracted data, synthesized results, and critically appraised studies using the Philips checklist. Cost data were presented in 2022 US Dollars RESULTS: Our search yielded 1,809 records, 47 of which were included. The majority of included studies were cost-utility analysis, published between 2018 and 2023, and conducted in the United States. Tisagenlecleucel, axicabtagene ciloleucel, idecabtagene vicleucel, ciltacabtagene autoleucel, lisocabtagene maraleucel, brexucabtagene autoleucel, and relmacabtagene autoleucel were compared to various standard-of-care chemotherapies. The incremental cost-effective ratio (ICER) for CAR-T therapies ranged from $9,424 to $4,124,105 per QALY in adults and from $20,784 to $243,177 per QALY in pediatric patients. ICERs were found to improve over longer time horizons or when an earlier cure point was assumed. Most studies failed to meet the Philips checklist due to a lack of head-to-head comparisons and uncertainty surrounding CAR-T costs and curative effects. CONCLUSIONS CAR-T therapies were more expensive and generated more QALYs than comparators, but their cost-effectiveness were uncertain and dependent on patient population, cancer type, and model assumptions. This highlights the need for more nuanced economic evaluations and continued research to better understand the value of CAR-T therapies in diverse patient populations.
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Affiliation(s)
- Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
| | - Emily Thompson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | - Srishti Kumar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | - Aliisa Heiskanen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | - Anubhav Agarwal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | - Harold Atkins
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Transplant and Cell Therapy Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Risa Shorr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | - Terry Hawrysh
- Patient Partner, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Manoj Mathew Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Hudek N, Carroll K, Semchishen S, Vanderhout S, Presseau J, Grimshaw J, Fergusson DA, Gillies K, Graham ID, Taljaard M, Brehaut JC. Describing the content of trial recruitment interventions using the TIDieR reporting checklist: a systematic methodology review. BMC Med Res Methodol 2024; 24:85. [PMID: 38589803 PMCID: PMC11000410 DOI: 10.1186/s12874-024-02195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Recruiting participants to clinical trials is an ongoing challenge, and relatively little is known about what recruitment strategies lead to better recruitment. Recruitment interventions can be considered complex interventions, often involving multiple components, targeting a variety of groups, and tailoring to different groups. We used the Template for Intervention Description and Replication (TIDieR) reporting checklist (which comprises 12 items recommended for reporting complex interventions) to guide the assessment of how recruitment interventions are described. We aimed to (1) examine to what extent we could identify information about each TIDieR item within recruitment intervention studies, and (2) observe additional detail for each item to describe useful variation among these studies. METHODS We identified randomized, nested recruitment intervention studies providing recruitment or willingness to participate rates from two sources: a Cochrane review of trials evaluating strategies to improve recruitment to randomized trials, and the Online Resource for Research in Clinical triAls database. First, we assessed to what extent authors reported information about each TIDieR item. Second, we developed descriptive categorical variables for 7 TIDieR items and extracting relevant quotes for the other 5 items. RESULTS We assessed 122 recruitment intervention studies. We were able to extract information relevant to most TIDieR items (e.g., brief rationale, materials, procedure) with the exception of a few items that were only rarely reported (e.g., tailoring, modifications, planned/actual fidelity). The descriptive variables provided a useful overview of study characteristics, with most studies using various forms of informational interventions (55%) delivered at a single time point (90%), often by a member of the research team (59%) in a clinical care setting (41%). CONCLUSIONS Our TIDieR-based variables provide a useful description of the core elements of complex trial recruitment interventions. Recruitment intervention studies report core elements of complex interventions variably; some process elements (e.g., mode of delivery, location) are almost always described, while others (e.g., duration, fidelity) are reported infrequently, with little indication of a reason for their absence. Future research should explore whether these TIDieR-based variables can form the basis of an approach to better reporting of elements of successful recruitment interventions.
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Affiliation(s)
- Natasha Hudek
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Seana Semchishen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Shelley Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Tricco AC, Parker A, Khan PA, Nincic V, Robson R, MacDonald H, Warren R, Cleary O, Zibrowski E, Baxter N, Burns KEA, Coyle D, Ndjaboue R, Clark JP, Langlois EV, Ahmed SB, Witteman HO, Graham ID, El-Adhami W, Skidmore B, Légaré F, Curran J, Hawker G, Watt J, Bourgeault IL, Leigh JP, Lawford K, Aiken A, McCabe C, Shepperd S, Pattani R, Leon N, Lundine J, Adisso ÉL, Ono S, Rabeneck L, Straus SE. Interventions on gender equity in the workplace: a scoping review. BMC Med 2024; 22:149. [PMID: 38581003 PMCID: PMC10998304 DOI: 10.1186/s12916-024-03346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity). METHODS Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework. RESULTS We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes. CONCLUSIONS There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex. TRIAL REGISTRATION Open Science Framework https://osf.io/x8yae .
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada.
| | - Amanda Parker
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Reid Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Rachel Warren
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Olga Cleary
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ruth Ndjaboue
- École de Travail Social, Université de Sherbrooke, Québec, (Québec), Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Greenway, Australia
| | | | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Karen Lawford
- Department of Gender Studies, Haudenosaunee and Anishinaabek Territories, Queen's University, Settlement of Kingston, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, Canada
| | | | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Reena Pattani
- Department of Medicine, Division of Internal Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Santa Ono
- Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
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Graham ND, Graham ID, Vanderspank-Wright B, Nadalin Penno L, Fergusson DA, Squires JE. Factors influencing nurses' use of sedation interruptions in a critical care unit: a descriptive qualitative study. JBI Evid Implement 2024:02205615-990000000-00085. [PMID: 38533695 DOI: 10.1097/xeb.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION AND AIMS This study examined critical care nurses', physicians', and allied health professionals' perceptions of factors that support, inhibit, or limit the use of sedation interruption (SI) to improve the use of this integral component of care for mechanically ventilated patients. METHOD We conducted a theory-based, descriptive qualitative study using semi-structured interviews with critical care registered nurses, respiratory therapists, a pharmacist, and a physician in a hospital in Ontario, Canada. The interview guide and analysis were informed by the Theoretical Domains Framework and transcripts were analyzed using content analysis. RESULTS We identified 9 facilitators and 20 barriers to SI use by nurses. Facilitators included the innovation (importance of protocols) and potential adopters (comfort with the skill). The barriers were the potential adopters' (nurses) knowledge gaps regarding the performance and goal of SI and the practice environment (lack of time, availability of extra staff, and lack of multidisciplinary rounds). CONCLUSION This study identified facilitators and barriers to SI for mechanically ventilated patients. Implementation efforts must address barriers associated with nurses, the environment, and contextual factors. A team-based approach is essential, as the absence of interprofessional rounds is a significant barrier to the appropriate use or non-use of SI. Future research can focus on the indications, contraindications, and goals of SI, emphasizing a shared appreciation for these factors across disciplines. Nursing capacity to manage a patient waking up from sedation is necessary for point-of-care adherence; future research should focus on the best ways to do so. Implementation study designs should use theory and evidence-based determinants of SI to bridge the evidence-to-practice gap. SPANISH ABSTRACT http://links.lww.com/IJEBH/A178.
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Affiliation(s)
- Nicole D Graham
- Faculty of Environmental and Health Sciences, Canadore College, North Bay, ON, Canada
| | - Ian D Graham
- Faculty of Environmental and Health Sciences, Canadore College, North Bay, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Letitia Nadalin Penno
- Faculty of Environmental and Health Sciences, Canadore College, North Bay, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Janet E Squires
- Faculty of Environmental and Health Sciences, Canadore College, North Bay, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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de Launay D, Paquet M, Kirkham AM, Graham ID, Fergusson DA, Nagpal SK, Shorr R, Grimshaw JM, Roberts DJ. Evidence for clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications among adults with peripheral artery disease: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e076795. [PMID: 38514143 PMCID: PMC10961494 DOI: 10.1136/bmjopen-2023-076795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION International guidelines recommend that adults with peripheral artery disease (PAD) be prescribed antiplatelet, statin and antihypertensive medications. However, it is unclear how often people with PAD are underprescribed these drugs, which characteristics predict clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications, and whether underprescription and non-adherence are associated with adverse health and health system outcomes. METHODS AND ANALYSIS We will search MEDLINE, EMBASE and Evidence-Based Medicine Reviews from 2006 onwards. Two investigators will independently review abstracts and full-text studies. We will include studies that enrolled adults and reported the incidence and/or prevalence of clinician underprescription of or patient non-adherence to guideline-recommended cardiovascular medications among people with PAD; adjusted risk factors for underprescription of/non-adherence to these medications; and adjusted associations between underprescription/non-adherence to these medications and outcomes. Outcomes will include mortality, major adverse cardiac and limb events (including revascularisation procedures and amputations), other reported morbidities, healthcare resource use and costs. Two investigators will independently extract data and evaluate study risk of bias. We will calculate summary estimates of the incidence and prevalence of clinician underprescription/patient non-adherence across studies. We will also conduct subgroup meta-analyses and meta-regression to determine if estimates vary by country, characteristics of the patients and treating clinicians, population-based versus non-population-based design, and study risks of bias. Finally, we will calculate pooled adjusted risk factors for underprescription/non-adherence and adjusted associations between underprescription/non-adherence and outcomes. We will use Grading of Recommendations, Assessment, Development and Evaluation to determine estimate certainty. ETHICS AND DISSEMINATION Ethics approval is not required as we are studying published data. This systematic review will synthesise existing evidence regarding clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications in adults with PAD. Results will be used to identify evidence-care gaps and inform where interventions may be required to improve clinician prescribing and patient adherence to prescribed medications. PROSPERO REGISTRATION NUMBER CRD42022362801.
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Affiliation(s)
- David de Launay
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Maude Paquet
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Aidan M Kirkham
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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Stokes Y, Cloutier P, Aggarwal D, Jacob JD, Hambrick E, Tricco AC, Ward MK, Kennedy A, Greenham S, Robb M, Sheppard R, Murphy D, Boggett J, Graham ID, Lewis KB. Youth, caregiver and healthcare professional perspectives on planning the implementation of a trauma-informed care programme: A qualitative study. J Adv Nurs 2024. [PMID: 38450840 DOI: 10.1111/jan.16095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
AIMS To explore youth, caregiver and staff perspectives on their vision of trauma-informed care, and to identify and understand potential considerations for the implementation of a trauma-informed care programme in an inpatient mental health unit within a paediatric hospital. DESIGN AND METHODS We applied the Interpretive Description approach, guided by complexity theory and the Implementation Roadmap, and used Applied Thematic Analysis methods. FINDINGS Twenty-five individuals participated in individual or group interviews between March and June 2022, including 21 healthcare professionals, 3 youth and 1 caregiver. We identified two overarching themes. The first theme, 'Understanding and addressing the underlying reasons for distress', related to participants' understanding and vision of TIC in the current setting comprising: (a) 'Participants' understanding of TIC'; (b) 'Trauma screening and trauma processing within TIC'; (c) 'Taking "a more individualized approach"'; (d) 'Unit programming'; and (e) "Connecting to the community". The second theme, 'Factors that support or limit successful TIC implementation' comprises: (a) 'The need for a broad "cultural shift"'; (b) 'The physical environment on the unit'; and (c) 'Factors that may limit successful implementation'. CONCLUSION We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of engagement with youth, caregivers and staff in trauma-informed care delivery and implementation, (b) trauma-informed care core programme components, (c) factors that may support or limit success in implementing trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration (partnering with external organizations and sectors). IMPACT When implementing TIC, there is an ongoing need to increase clarity regarding TIC interventions and implementation initiatives. Youth, caregiver and healthcare professional participants shared considerations important for planning the delivery and implementation of trauma-informed care in their setting. We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of relational engagement, (b) trauma-informed care programme components, (c) factors that may support or limit successful implementation of trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration. Organizations wishing to implement trauma-informed care should consider ongoing engagement with all relevant knowledge user groups throughout the process. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION The local hospital research institute's Patient and Family Advisory Committee reviewed the draft study methods and provided feedback.
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Affiliation(s)
- Yehudis Stokes
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Dhiraj Aggarwal
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | | | - Erin Hambrick
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, School of Nursing, Queen's University Kingston, Kingston, Ontario, Canada
| | - Michelle K Ward
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Allison Kennedy
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Greenham
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Marjorie Robb
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Roxanna Sheppard
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - David Murphy
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Jennifer Boggett
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Ian D Graham
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Krystina B Lewis
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Lewis KB, Smith M, Stacey D, Carley M, Graham ID. Evaluation of an integrated knowledge translation approach used for updating the Cochrane Review of Patient Decision Aids: a pre-post mixed methods study. Res Involv Engagem 2024; 10:21. [PMID: 38331835 PMCID: PMC10854135 DOI: 10.1186/s40900-024-00550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND When people who can use or benefit from research findings are engaged as partners on study teams, the quality and impact of findings are better. These people can include patients/consumers and clinicians who do not identify as researchers. They are referred to as "knowledge users". This partnered approach is called integrated knowledge translation (IKT). We know little about knowledge users' involvement in the conduct of systematic reviews. We aimed to evaluate team members' degree of meaningful engagement and their perceptions of having used an IKT approach when updating the Cochrane Review of Patient Decision Aids. METHODS We conducted a pre-post mixed methods study. We surveyed all team members at two time points. Before systematic review conduct, all participating team members indicated their preferred level of involvement within each of the 12 steps of the systematic review process from "Screen titles/abstracts" to "Provide feedback on draft article". After, they reported on their degree of satisfaction with their achieved level of engagement across each step and the degree of meaningful engagement using the Patient Engagement In Research Scale (PEIRS-22) across 7 domains scored from 100 (extremely meaningful engagement) to 0 (no meaningful engagement). We solicited their experiences with the IKT approach using open-ended questions. We analyzed quantitative data descriptively and qualitative data using content analysis. We triangulated data at the level of study design and interpretation. RESULTS Of 21 team members, 20 completed the baseline survey (95.2% response rate) and 17/20 (85.0% response rate) the follow-up survey. There were 11 (55%) researchers, 3 (15%) patients/consumers, 5 (25%) clinician-researchers, and 1 (5%) graduate student. At baseline, preferred level of involvement in the 12 systematic review steps varied from n = 3 (15%) (search grey literature sources) to n = 20 (100%) (provide feedback on the systematic review article). At follow-up, 16 (94.1%) participants were totally or very satisfied with the extent to which they were involved in these steps. All (17, 100%) agreed that the process was co-production. Total PEIRS-22 scores revealed most participants reported extremely (13, 76.4%) or very (2, 11.8%) meaningful degree of engagement. Triangulated data revealed that participants indicated benefit to having been engaged in an authentic research process that incorporated diverse perspectives, resulting in better and more relevant outputs. Reported challenges were about time, resources, and the logistics of collaborating with a large group. CONCLUSION Following the use of an IKT approach during the conduct of a systematic review, team members reported high levels of meaningful engagement. These results contribute to our understanding of ways to co-produce systematic reviews.
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Affiliation(s)
- Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Maureen Smith
- Knowledge User, Ottawa, ON, Canada
- Cochrane Consumer, Ottawa, ON, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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8
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Hartley T, Marshall D, Acker M, Fooks K, Gillespie MK, Price EM, Graham ID, White-Brown A, MacKay L, Macdonald SK, Brady L, Hui AY, Andrews JD, Chowdhury A, Wall E, Soubry É, Ediae GU, Rojas S, Assamad D, Dyment D, Tarnopolsky M, Sawyer SL, Chisholm C, Lemire G, Amburgey K, Lazier J, Mendoza-Londono R, Dowling JJ, Balci TB, Armour CM, Bhola PT, Costain G, Dupuis L, Carter M, Badalato L, Richer J, Boswell-Patterson C, Kannu P, Cordeiro D, Warman-Chardon J, Graham G, Siu VM, Cytrynbaum C, Rusnak A, Aul RB, Yoon G, Gonorazky H, McNiven V, Mercimek-Andrews S, Guerin A, Deshwar AR, Marwaha A, Weksberg R, Karp N, Campbell M, Al-Qattan S, Shuen AY, Inbar-Feigenberg M, Cohn R, Szuto A, Inglese C, Poirier M, Chad L, Potter B, Boycott KM, Hayeems R. Evaluation of the diagnostic accuracy of exome sequencing and its impact on diagnostic thinking for patients with rare disease in a publicly funded health care system: A prospective cohort study. Genet Med 2024; 26:101012. [PMID: 37924259 DOI: 10.1016/j.gim.2023.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE To evaluate the diagnostic utility of publicly funded clinical exome sequencing (ES) for patients with suspected rare genetic diseases. METHODS We prospectively enrolled 297 probands who met eligibility criteria and received ES across 5 sites in Ontario, Canada, and extracted data from medical records and clinician surveys. Using the Fryback and Thornbury Efficacy Framework, we assessed diagnostic accuracy by examining laboratory interpretation of results and assessed diagnostic thinking by examining the clinical interpretation of results and whether clinical-molecular diagnoses would have been achieved via alternative hypothetical molecular tests. RESULTS Laboratories reported 105 molecular diagnoses and 165 uncertain results in known and novel genes. Of these, clinicians interpreted 102 of 105 (97%) molecular diagnoses and 6 of 165 (4%) uncertain results as clinical-molecular diagnoses. The 108 clinical-molecular diagnoses were in 104 families (35% diagnostic yield). Each eligibility criteria resulted in diagnostic yields of 30% to 40%, and higher yields were achieved when >2 eligibility criteria were met (up to 45%). Hypothetical tests would have identified 61% of clinical-molecular diagnoses. CONCLUSION We demonstrate robustness in eligibility criteria and high clinical validity of laboratory results from ES testing. The importance of ES was highlighted by the potential 40% of patients that would have gone undiagnosed without this test.
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Affiliation(s)
- Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada.
| | | | | | - Katharine Fooks
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - E Magda Price
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Ian D Graham
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Layla MacKay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Stella K Macdonald
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lauren Brady
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Angela Y Hui
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Joseph D Andrews
- London Health Sciences Centre, Western University, London, Canada
| | - Ashfia Chowdhury
- London Health Sciences Centre, Western University, London, Canada
| | - Erika Wall
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Élisabeth Soubry
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Grace U Ediae
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Samantha Rojas
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - David Dyment
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Mark Tarnopolsky
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Sarah L Sawyer
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Gabrielle Lemire
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada
| | - Kimberly Amburgey
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Joanna Lazier
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - James J Dowling
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Tugce B Balci
- London Health Sciences Centre, Western University, London, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Priya T Bhola
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Gregory Costain
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Lucie Dupuis
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Melissa Carter
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lauren Badalato
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Julie Richer
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Peter Kannu
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; The Ottawa Hospital, Ottawa, Canada
| | | | - Jodi Warman-Chardon
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; University of Alberta, Edmonton, Alberta, Canada
| | - Gail Graham
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Victoria Mok Siu
- London Health Sciences Centre, Western University, London, Canada
| | - Cheryl Cytrynbaum
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Alison Rusnak
- University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada; Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Ritu B Aul
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Grace Yoon
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Hernan Gonorazky
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | | | - Andrea Guerin
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Ashish R Deshwar
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Ashish Marwaha
- University of Calgary, Calgary, Canada; Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; The Ottawa Hospital, Ottawa, Canada
| | - Rosanna Weksberg
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Natalya Karp
- London Health Sciences Centre, Western University, London, Canada
| | - Maggie Campbell
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Sarah Al-Qattan
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Andrew Y Shuen
- University of Toronto, Toronto, Canada; McMaster Children's Hospital, McMaster University, Hamilton, Canada; London Health Sciences Centre, Western University, London, Canada
| | | | - Ronald Cohn
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Anna Szuto
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Cara Inglese
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - Lauren Chad
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Beth Potter
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Robin Hayeems
- Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada.
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Chen W, Graham ID, Hu J, Lewis KB, Gifford W. Nurse managers' perceptions of the prospective acceptability of an implementation leadership training programme: A qualitative descriptive study. J Adv Nurs 2024. [PMID: 38186229 DOI: 10.1111/jan.16047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/19/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To explore the prospective acceptability of an implementation leadership training programme prototype for nurse managers in China to implement evidence-based practices, from the perspectives of potential programme participants and deliverers. DESIGN A qualitative descriptive study was conducted in Spring 2022 at three tertiary hospitals in Hunan, China. METHODS We conducted individual semi-structured interviews with unit-level nurse managers (n = 14), including 12 potential participants, and two potential deliverers that have been involved in developing the programme prototype. Interview questions and thematic analysis were guided by the Theoretical Framework of Acceptability. RESULTS After reviewing the programme content, potential participants and deliverers reported that unit nurse managers would benefit from engaging in the programme, acknowledging that the programme fit with professional nursing values for implementing research evidence. They expressed positive views about being involved in producing academic papers through the training process, and interactive multi-modal training activities such as group work, experience-sharing and coaching. Seven participants were not very confident about being fully engaged in the training, as they could not navigate the English research literature. Both participants and deliverers highlighted factors that would influence their participation, including time constraints, the impact of the COVID-19 pandemic, and support from senior organizational leadership. CONCLUSIONS The training programme prototype was perceived to be useful and acceptable. The multimodal training activities were considered a strength and managers expressed an interest in writing academic papers about their implementation processes. Support from senior hospital leaders and programme deliverers was identified as critical to the training programme's success. IMPACT The study helps understand nurse managers' perceptions and concerns of participating in an implementation leadership training programme and could inform the development and refinement of similar programmes in various nursing contexts globally.
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Affiliation(s)
- Wenjun Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
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11
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Bhuiya AR, Sutherland J, Boateng R, Bain T, Skidmore B, Perrier L, Makarski J, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Puchalski Ritchie LM, Squires JE, Rac VE, Fahim C, Kastner M. A scoping review reveals candidate quality indicators of knowledge translation and implementation science practice tools. J Clin Epidemiol 2024; 165:111205. [PMID: 37939744 DOI: 10.1016/j.jclinepi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To identify candidate quality indicators from existing tools that provide guidance on how to practice knowledge translation and implemenation science (KT practice tools) across KT domains (dissemination, implementation, sustainability, and scalability). STUDY DESIGN AND SETTING We conducted a scoping review using the Joanna Briggs Institute Manual for Evidence Synthesis. We systematically searched multiple electronic databases and the gray literature. Documents were independently screened, selected, and extracted by pairs of reviewers. Data about the included articles, KT practice tools, and candidate quality indicators were analyzed, categorized, and summarized descriptively. RESULTS Of 43,060 titles and abstracts that were screened from electronic databases and gray literature, 850 potentially relevant full-text articles were identified, and 253 articles were included in the scoping review. Of these, we identified 232 unique KT practice tools from which 27 unique candidate quality indicators were generated. The identified candidate quality indicators were categorized according to the development (n = 17), evaluation (n = 5) and adaptation (n = 3) of the tools, and engagement of knowledge users (n = 2). No tools were identified that appraised the quality of KT practice tools. CONCLUSIONS The development of a quality appraisal instrument of KT practice tools is needed. The results will be further refined and finalized in order to develop a quality appraisal instrument for KT practice tools.
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
| | - Justin Sutherland
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Rhonda Boateng
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Téjia Bain
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Becky Skidmore
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Sarah Munce
- University Health Network, Toronto, Ontario, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ontario, Canada; National Collaborating Centre for Methods and Tools, Hamilton, Ontario, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Valeria E Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Research and Innovation, North York, Ontario, Canada
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Mrklas KJ, Boyd JM, Shergill S, Merali S, Khan M, Moser C, Nowell L, Goertzen A, Swain L, Pfadenhauer LM, Sibley KM, Vis-Dunbar M, Hill MD, Raffin-Bouchal S, Tonelli M, Graham ID. A scoping review of the globally available tools for assessing health research partnership outcomes and impacts. Health Res Policy Syst 2023; 21:139. [PMID: 38129871 PMCID: PMC10740226 DOI: 10.1186/s12961-023-00958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 01/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Health research partnership approaches have grown in popularity over the past decade, but the systematic evaluation of their outcomes and impacts has not kept equal pace. Identifying partnership assessment tools and key partnership characteristics is needed to advance partnerships, partnership measurement, and the assessment of their outcomes and impacts through systematic study. OBJECTIVE To locate and identify globally available tools for assessing the outcomes and impacts of health research partnerships. METHODS We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL + , PsychINFO) with an a priori strategy from inception to June 2021, without limits. We screened studies independently and in duplicate, keeping only those involving a health research partnership and the development, use and/or assessment of tools to evaluate partnership outcomes and impacts. Reviewer disagreements were resolved by consensus. Study, tool and partnership characteristics, and emerging research questions, gaps and key recommendations were synthesized using descriptive statistics and thematic analysis. RESULTS We screened 36 027 de-duplicated citations, reviewed 2784 papers in full text, and kept 166 studies and three companion reports. Most studies originated in North America and were published in English after 2015. Most of the 205 tools we identified were questionnaires and surveys targeting researchers, patients and public/community members. While tools were comprehensive and usable, most were designed for single use and lacked validity or reliability evidence. Challenges associated with the interchange and definition of terms (i.e., outcomes, impacts, tool type) were common and may obscure partnership measurement and comparison. Very few of the tools identified in this study overlapped with tools identified by other, similar reviews. Partnership tool development, refinement and evaluation, including tool measurement and optimization, are key areas for future tools-related research. CONCLUSION This large scoping review identified numerous, single-use tools that require further development and testing to improve their psychometric and scientific qualities. The review also confirmed that the health partnership research domain and its measurement tools are still nascent and actively evolving. Dedicated efforts and resources are required to better understand health research partnerships, partnership optimization and partnership measurement and evaluation using valid, reliable and practical tools that meet partners' needs.
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Affiliation(s)
- Kelly J Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10-3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, AB, Canada.
| | - Jamie M Boyd
- Knowledge Translation Program, St Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Sumair Shergill
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sera Merali
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Masood Khan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Cheryl Moser
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lorelli Nowell
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Amelia Goertzen
- Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Liam Swain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10-3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, and Epidemiology-IBE, Ludwig-Maximilians Universität Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | | | - Michael D Hill
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10-3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Departments of Clinical Neurosciences, Medicine and Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Office of the Vice-President (Research), University of Calgary, Calgary, AB, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Schools of Epidemiology and Public Health and Nursing, University of Ottawa, Ottawa, ON, Canada
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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Reszel J, Daub O, Leese J, Augustsson H, Bellows DM, Cassidy CE, Crowner BE, Dunn SI, Goodwin LB, Hoens AM, Hunter SC, Lynch EA, Moore JL, Rafferty MR, Romney W, Stacey D, Graham ID. Essential content for teaching implementation practice in healthcare: a mixed-methods study of teams offering capacity-building initiatives. Implement Sci Commun 2023; 4:151. [PMID: 38012798 PMCID: PMC10680357 DOI: 10.1186/s43058-023-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals' and teams' ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. METHODS We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives' content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. RESULTS Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. CONCLUSIONS This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Danielle Moeske Bellows
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, USA
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
| | | | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
| | - Lisa B Goodwin
- Inpatient Rehabilitation, University of Vermont Medical Center, Colchester, USA
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Jennifer L Moore
- Regional Rehabilitation Knowledge Center, Sunnaas Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, Indiana, USA
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab and Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
| | - Wendy Romney
- Physical Therapy, Sacred Heart University, Fairfield, USA
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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15
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Hartley T, Gillespie MK, Graham ID, Hayeems RZ, Li S, Sampson M, Boycott KM, Potter BK. Exome and genome sequencing for rare genetic disease diagnosis: A scoping review and critical appraisal of clinical guidance documents produced by genetics professional organizations. Genet Med 2023; 25:100948. [PMID: 37551668 DOI: 10.1016/j.gim.2023.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE Exome and genome sequencing have rapidly transitioned from research methods to widely used clinical tests for diagnosing rare genetic diseases. We sought to synthesize the topics covered and appraise the development processes of clinical guidance documents generated by genetics professional organizations. METHODS We conducted a scoping review of guidance documents published since 2010, systematically identified in peer-reviewed and gray literature, using established methods and reporting guidelines. We coded verbatim recommendations by topic using content analysis and critically appraised documents using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. RESULTS We identified 30 guidance documents produced by 8 organizations (2012-2022), yielding 611 recommendations covering 21 topics. The most common topic related to findings beyond the primary testing indication. Mean AGREE II scores were low across all 6 quality domains; scores for items related to rigor of development were among the lowest. More recently published documents generally received higher scores. CONCLUSION Guidance documents included a broad range of recommendations but were of low quality, particularly in their rigor of development. Developers should consider using tools such as AGREE II and basing recommendations on living knowledge syntheses to improve guidance development in this evolving space.
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Affiliation(s)
- Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
| | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ian D Graham
- University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Sheena Li
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Reszel J, Daub O, Dunn SI, Cassidy CE, Hafizi K, Lightfoot M, Pervez D, Quosdorf A, Wood A, Graham ID. Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis. BMC Pregnancy Childbirth 2023; 23:735. [PMID: 37848826 PMCID: PMC10583424 DOI: 10.1186/s12884-023-06042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Marnie Lightfoot
- Women and Children's Health Network, Orillia Soldiers' Memorial Hospital, 170 Colborne St W, Orillia, ON, L3V 2Z3, Canada
| | | | - Ashley Quosdorf
- Neonatal Intensive Care Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Allison Wood
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Shaw JF, Ouyang Y, Fergusson DA, McArdle T, Martin C, Cook D, Graham ID, Hawken S, McCartney CJL, Menon K, Saginur R, Seely A, Stiell I, Fox-Robichaud A, English S, Marshall J, Thavorn K, Taljaard M, McIntyre LA. A Hospital-Wide Open-Label Cluster Crossover Pragmatic Comparative Effectiveness Randomized Trial Comparing Normal Saline to Ringer's Lactate: Protocol and Statistical Analysis Plan of The FLUID Trial. JMIR Res Protoc 2023; 12:e51783. [PMID: 37801356 PMCID: PMC10589831 DOI: 10.2196/51783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Normal saline (NS) and Ringer's lactate (RL) are the most common crystalloids given to hospitalized patients. Despite concern about possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function, and death), few large multicenter randomized trials focused on critically ill patients have compared these fluids. Uncertainty exists about the effects of these fluids on clinically important outcomes across all hospitalized patients. OBJECTIVE The FLUID trial is a pragmatic, multicenter, 2×2 cluster crossover comparative effectiveness randomized trial that aims to evaluate the effectiveness of a hospital-wide policy that stocks either NS or RL as the main crystalloid fluid in 16 hospitals across Ontario, Canada. METHODS All hospitalized adult and pediatric patients (anticipated sample size 144,000 patients) with an incident admission to the hospital over the course of each study period will be included. Either NS or RL will be preferentially stocked throughout the hospital for 12 weeks before crossing to the alternate fluid for the subsequent 12 weeks. The primary outcome is a composite of death and hospital readmission within 90 days of hospitalization. Secondary outcomes include death, hospital readmission, dialysis, reoperation, postoperative reintubation, length of hospital stay, emergency department visits, and discharge to a facility other than home. All outcomes will be obtained from health administrative data, eliminating the need for individual case reports. The primary analysis will use cluster-level summaries to estimate cluster-average treatment effects. RESULTS The statistical analysis plan has been prepared "a priori" in advance of receipt of the trial data set from ICES and any analyses. CONCLUSIONS We describe the protocol and statistical analysis plan for the evaluation of primary and secondary outcomes for the FLUID trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04512950; https://classic.clinicaltrials.gov/ct2/show/NCT04512950. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51783.
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Affiliation(s)
- Julia F Shaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Yongdong Ouyang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Tracy McArdle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Claudio Martin
- Division of Critical Care Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Deborah Cook
- Departments of Medicine, Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- ICES, University of Ottawa, Ottawa, ON, Canada
| | | | - Kusum Menon
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Raphael Saginur
- Department of Medicine, Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
| | - Andrew Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ian Stiell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alison Fox-Robichaud
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, ON, Canada
| | - John Marshall
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- ICES, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lauralyn A McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, ON, Canada
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Taccone MS, Baudais N, Wood D, Bays S, Frost S, Urquhart R, Graham ID, Takacs J. Co-creation of a patient engagement strategy in cancer research funding. Res Involv Engagem 2023; 9:86. [PMID: 37775825 PMCID: PMC10542220 DOI: 10.1186/s40900-023-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND As research teams, networks, and institutes, and health, medical, and scientific communities begin to build consensus on the benefits of patient engagement in cancer research, research funders are increasingly looking to meaningfully incorporate patient partnership within funding processes and research requirements. The Canadian Cancer Society (CCS), the largest non-profit cancer research funder in Canada, set out to co-create a patient engagement in cancer research strategy with patients, survivors, caregivers and researchers. The goal of this strategy was to meaningfully and systematically engage with patients in research funding and research activities. METHODS A team of four patient partners with diverse cancer and personal experiences, and two researchers at different career stages agreed to participate as members of the strategy team. Ten staff members participated in supportive roles and to give context regarding different departments of CCS. The strategy was co-developed in 2021/2022 over a series of 7 workshops using facilitation strategies such as ground rules and consensus building, and methods such as Design Thinking. The strategy was subjected to 3 rounds of validation. RESULTS The co-creation and validation process resulted in a multi-faceted strategy with actionable sections, including vision, guiding principles, engagement methods, 13 prioritized engagement activities spanning the spectrum of research funding, and an evaluation framework. The experience of co-creating the strategy was captured using the Patient and Public Engagement Evaluation Tool and revealed a positive, supportive experience. CONCLUSIONS Lessons learned included the value of an emphasis on a co-creation process from day one, the utility of facilitation techniques such as ground rules for dialogue, consensus building and Design Thinking, and the importance (and challenge) of designing for and incorporating equity when drafting the strategy. Future work will include implementation and evaluation of the strategy, as well as an examination of further ways to meaningfully and systematically engage diverse voices in research and research funding.
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Affiliation(s)
| | - Nathalie Baudais
- Canadian Cancer Society, 55 St Clair Ave W Suite 500, Toronto, ON, M4V 2Y7, Canada
| | - Don Wood
- Canadian Cancer Society, 55 St Clair Ave W Suite 500, Toronto, ON, M4V 2Y7, Canada
| | - Suzanne Bays
- Canadian Cancer Society, 55 St Clair Ave W Suite 500, Toronto, ON, M4V 2Y7, Canada
| | - Sasha Frost
- Canadian Cancer Society, 55 St Clair Ave W Suite 500, Toronto, ON, M4V 2Y7, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Ian D Graham
- Schools of Epidemiology and Public Health & Nursing, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, ON, K1H 8L6, Canada
| | - Judit Takacs
- Canadian Cancer Society, 55 St Clair Ave W Suite 500, Toronto, ON, M4V 2Y7, Canada.
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Stokes Y, Lewis KB, Tricco AC, Hambrick E, Jacob JD, Demery Varin M, Gould J, Aggarwal D, Cloutier P, Landriault C, Greenham S, Ward M, Kennedy A, Boggett J, Sheppard R, Murphy D, Robb M, Gandy H, Lavergne S, Graham ID. Trauma-Informed Care Interventions Used in Pediatric Inpatient or Residential Treatment Mental Health Settings and Strategies to Implement Them: A Scoping Review. Trauma Violence Abuse 2023:15248380231193444. [PMID: 37694809 DOI: 10.1177/15248380231193444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Trauma-informed care (TIC) is an approach to care emerging in research and in practice that involves addressing the needs of individuals with histories of trauma. The aim of this scoping review was to examine the current literature relating to TIC interventions used in pediatric mental health inpatient and residential settings. We sought to answer the following two research questions: (a) What are the TIC interventions used in pediatric inpatient and residential treatment mental healthcare settings and what are their components? and (b) What are the implementation goals and strategies used with these TIC interventions? We conducted this scoping review according to JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. We included any primary study describing a TIC intervention that was implemented at a specific site which identified and described implementation strategies used. Of 1,571 identified citations and 54 full-text articles located by handsearching, 49 met the eligibility criteria and were included, representing 21 distinct TIC interventions. We present the reported aim, ingredients, mechanism, and delivery (AIMD) of TIC interventions as well as the implementation goals and strategies used, which varied in detail, ranging from very little information to more detailed descriptions. In the context of these findings, we emphasize the complexity of TIC and of TIC interventions, and the importance of identifying and clearly reporting TIC intervention goals, intervention details, and implementation strategies. We suggest applying intervention frameworks or reporting guidelines to support clear and comprehensive reporting, which would better facilitate replication and synthesis of published TIC interventions.
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Affiliation(s)
- Yehudis Stokes
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Krystina B Lewis
- University of Ottawa, ON, Canada
- University of Ottawa Heart Institute, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Andrea C Tricco
- Queen's University, Kingston, ON, Canada
- University of Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, ON, Canada
| | | | | | - Melissa Demery Varin
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Justine Gould
- CHEO Research Institute, Ottawa, Canada
- Queen's University, Kingston, ON, Canada
| | - Dhiraj Aggarwal
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - Stephanie Greenham
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Michelle Ward
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Allison Kennedy
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - David Murphy
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Marjorie Robb
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Hazen Gandy
- University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Sonia Lavergne
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Ian D Graham
- University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
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20
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Sibley KM, Khan M, Touchette AJ, Crockett LK, Driedger SM, Gainforth HL, Prabhu D, Steliga D, Tefft O, Graham ID. Characterizing Canadian funded partnered health research projects between 2011 and 2019: a retrospective analysis. Health Res Policy Syst 2023; 21:92. [PMID: 37684637 PMCID: PMC10492355 DOI: 10.1186/s12961-023-01046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND AND AIMS Involving research users in collaborative research approaches may increase the relevance and utility of research findings. Our primary objectives were to (i) identify and describe characteristics of Canadian federally and provincially funded health research projects that included research users and were funded between 2011 and 2019; (ii) explore changes over time; and (iii) compare characteristics between funder required and optional partnerships. METHODS Retrospective analysis. Inclusion criteria were projects that included research users. We analyzed publicly available project variables, and coded field and type of research using established classification systems. We summarized data with descriptive statistics and compared variables across three funding year blocks and partnership requirement status. RESULTS We identified 1153 partnered health research projects, representing 137 fields of research and 37 types of research categories. Most projects included a required partnership (80%) and fell into health and social care services research (66%). Project length and funding amount increased from average of 24.8 months and $266 248 CAD in 2011-2013 to 31.6 months and $438 766 CAD in 2017-2019. There were significantly fewer required partnerships in 2017-2019. CONCLUSIONS Between 2011 and 2019 Canadian federally and provincially funded partnered health research reflected primarily care services research across many fields. The observed breadth suggests that partnered health research approaches are applicable in many fields of research. Additional work to support partnered research across all types of health research (especially biomedical research) is warranted. The administration of larger grants that are funded for longer time periods may address previously identified concerns among research teams engaging in partnered research but may mean that fewer teams receive funding and risk delaying responding to time-sensitive data needs for users. Our process and findings can be used as a starting point for international comparison.
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Affiliation(s)
- Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Masood Khan
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Alexie J Touchette
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Leah K Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Kelowna, BC, Canada
| | - Devashree Prabhu
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Dawn Steliga
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Olivia Tefft
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Dunn SI, Bhati DK, Reszel J, Kothari A, McCutcheon C, Graham ID. Understanding how and under what circumstances integrated knowledge translation works for people engaged in collaborative research: metasynthesis of IKTRN casebooks. JBI Evid Implement 2023; 21:277-293. [PMID: 36988573 DOI: 10.1097/xeb.0000000000000367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION AND AIMS Interaction and collaboration between researchers, patients/public, clinicians, managers and policy-makers are necessary to enhance the relevance and use of research, improve planning, and optimize healthcare delivery and outcomes. The Integrated Knowledge Translation Research Network (IKTRN) published four casebooks from 2019 to 2021, describing varied approaches to research co-production. Our aim was to examine the case studies to extend existing theoretical and empirical perspectives about how co-production works. METHODS We used metasynthesis, a qualitative research design that includes seven iterative steps (clarify the purpose, delineate the case studies included, extract and code the data, derive themes from the coded data, determine the relationships of the themes to research co-production, synthesize the concepts, and build theory). RESULTS A total of 35 cases was reviewed. The aggregate findings of this metasynthesis identified multiple contextual and process factors, barriers, and facilitators that influence integrated knowledge translation (IKT), and a range of IKT activities that increased the likelihood of success of co-production during research. In comparing the findings from the metasynthesis with existing literature, we found a number of consistencies, but also new information about barriers, facilitators, IKT activities and outcomes, thereby adding to our understanding about factors that influence co-production. CONCLUSIONS This metasynthesis provided concrete examples to optimize co-produced clinical and health system research. More research is needed to fully understand how to overcome some challenging modifiable barriers, establish relationships, facilitate communication, overcome power differentials and create processes for knowledge-users working across boundaries (clinical practice and research) to stay engaged and participate fully in research endeavours.
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Affiliation(s)
- Sandra I Dunn
- Ottawa Hospital Research Institute, Ottawa
- School of Nursing, University of Ottawa, Ottawa
| | | | - Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa
- School of Nursing, University of Ottawa, Ottawa
| | - Anita Kothari
- School of Health Studies, Western University, London
| | | | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa
- School of Nursing, University of Ottawa, Ottawa
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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22
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Graham ND, Graham ID, Vanderspank-Wright B, Varin MD, Nadalin Penno L, Fergusson DA, Squires JE. A systematic review and critical appraisal of guidelines and their recommendations for sedation interruptions in adult mechanically ventilated patients. Aust Crit Care 2023; 36:889-901. [PMID: 36522246 DOI: 10.1016/j.aucc.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objectives of the review were to (i) assess the methodological quality of all accessible and published guidelines and care bundles that offer a recommendation related to sedation interruptions, using the AGREE-II instrument, to (ii) determine what is the recommended best practice for sedation interruptions from the available guidelines, and then to have (iii) a closer inspection of the overall credibility and applicability of the recommendations using the AGREE-REX instrument. This review will benefit the outcomes of critically ill patients and the multidisciplinary team responsible for the care of mechanically ventilated adults with continuous medication infusions by providing a synthesis of the recommended action(s), actor(s), contextual information, target(s), and timing related to sedation interruptions from current best practice. REVIEW METHOD USED We conducted a systematic review. DATA SOURCES We applied a peer-reviewed search strategy to four electronic databases from 2010 to November 2021-MEDLINE, CINAHL, Embase, and The Cochrane Database of Systematic Reviews-and included grey literature. REVIEW METHOD Findings are reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II and AGREE Recommendation Excellence tools. RESULTS We identified 11 clinical practice guidelines and care bundles comprising 15 recommendations related to sedation interruption. There are three key findings: (i) deficiencies exist with the methodological quality of included guidelines, (ii) sedation interruption is recommended practice for the care of adult mechanically ventilated patients, and (iii) the current evidence is of low quality, which impacts overall credibility and applicability of the recommendations. CONCLUSIONS Sedation interruptions are currently best practice for adult mechanically ventilated patients; however, the available guidelines and recommendations have several deficiencies. Future research is needed to further understand the role of the nurse and other actors to enact this practice.
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Affiliation(s)
- Nicole D Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Brandi Vanderspank-Wright
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Melissa Demery Varin
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Letitia Nadalin Penno
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
| | - Janet E Squires
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
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23
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Squires JE, Graham ID, Santos WJ, Hutchinson AM. The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in healthcare. Health Res Policy Syst 2023; 21:81. [PMID: 37550737 PMCID: PMC10408185 DOI: 10.1186/s12961-023-01028-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND There is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals' use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals' use of research evidence and the effectiveness of implementation interventions in clinical practice. METHODS We conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science. RESULTS In the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes. CONCLUSIONS The Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals' use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.
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Affiliation(s)
- Janet E Squires
- School of Nursing, University of Ottawa, Ottawa, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Ian D Graham
- School of Nursing, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Wilmer J Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
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Tugwell P, Welch V, Magwood O, Todhunter-Brown A, Akl EA, Concannon TW, Khabsa J, Morley R, Schunemann H, Lytvyn L, Agarwal A, Antequera A, Avey MT, Campbell P, Chang C, Chang S, Dans L, Dewidar O, Ghersi D, Graham ID, Hazlewood G, Hilgart J, Horsley T, John D, Jull J, Maxwell LJ, McCutcheon C, Munn Z, Nonino F, Pardo Pardo J, Parker R, Pottie K, Rada G, Riddle A, Synnot A, Ghogomu ET, Tomlinson E, Toupin-April K, Petkovic J. Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses. Syst Rev 2023; 12:134. [PMID: 37533051 PMCID: PMC10394942 DOI: 10.1186/s13643-023-02279-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/18/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Involving collaborators and partners in research may increase relevance and uptake, while reducing health and social inequities. Collaborators and partners include people and groups interested in health research: health care providers, patients and caregivers, payers of health research, payers of health services, publishers, policymakers, researchers, product makers, program managers, and the public. Evidence syntheses inform decisions about health care services, treatments, and practice, which ultimately affect health outcomes. Our objectives are to: A. Identify, map, and synthesize qualitative and quantitative findings related to engagement in evidence syntheses B. Explore how engagement in evidence synthesis promotes health equity C. Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement in evidence syntheses METHODS: Our diverse, international team will develop guidance for engagement with collaborators and partners throughout multiple sequential steps using an integrated knowledge translation approach: 1. Reviews. We will co-produce 1 scoping review, 3 systematic reviews and 1 evidence map focusing on (a) methods, (b) barriers and facilitators, (c) conflict of interest considerations, (d) impacts, and (e) equity considerations of engagement in evidence synthesis. 2. Methods study, interviews, and survey. We will contextualise the findings of step 1 by assessing a sample of evidence syntheses reporting on engagement with collaborators and partners and through conducting interviews with collaborators and partners who have been involved in producing evidence syntheses. We will use these findings to develop draft guidance checklists and will assess agreement with each item through an international survey. 3. CONSENSUS The guidance checklists will be co-produced and finalised at a consensus meeting with collaborators and partners. 4. DISSEMINATION We will develop a dissemination plan with our collaborators and partners and work collaboratively to improve adoption of our guidance by key organizations. CONCLUSION Our international team will develop guidance for collaborator and partner engagement in health care evidence syntheses. Incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
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Affiliation(s)
- Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Olivia Magwood
- Bruyere Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Thomas W Concannon
- The RAND Corporation and Tufts University School of Medicine, Boston, MA, USA
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Holger Schunemann
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, ON, Canada
| | | | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marc T Avey
- Canadian Council On Animal Care, Ottawa, Canada
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christine Chang
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Leonila Dans
- Department of Clinical Epidemiology, University of the Philippines-Manila, Manila, Philippines
| | | | - Davina Ghersi
- Research Translation, National Health and Medical Research Council, Canberra, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ian D Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Tanya Horsley
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Denny John
- PharmaQuant, Kolkata, India
- Center for Public Health Research (CPHR), Kolkata, India
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Chris McCutcheon
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zachary Munn
- Faculty of Health and Medical Sciences, JBI, University of Adelaide, Adelaide, South Australia, Australia
| | - Francesco Nonino
- Unit of Epidemiology and Statistics, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Jordi Pardo Pardo
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, Canada
| | - Roses Parker
- Cochrane Pain Palliative and Supportive Care, Oxford University Hospitals Trust, Oxford, England
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile
- UC Evidence Centre and Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison Riddle
- Bruyere Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anneliese Synnot
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne Victoria, 3004, Australia
- Centre for Health Communication and Participation, School of Public Health and Psychological Sciences, La Trobe University, Plenty Rd, Bundoora, VIC, 3086, Australia
| | - Elizabeth Tanjong Ghogomu
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Eve Tomlinson
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Jennifer Petkovic
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Bruyere Research Institute, Ottawa, Canada.
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Veroniki AA, Soobiah C, Nincic V, Lai Y, Rios P, MacDonald H, Khan PA, Ghassemi M, Yazdi F, Brownson RC, Chambers DA, Dolovich LR, Edwards A, Glasziou PP, Graham ID, Hemmelgarn BR, Holmes BJ, Isaranuwatchai W, Legare F, McGowan J, Presseau J, Squires JE, Stelfox HT, Strifler L, Van der Weijden T, Fahim C, Tricco AC, Straus SE. Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions. BMC Med 2023; 21:269. [PMID: 37488589 PMCID: PMC10367354 DOI: 10.1186/s12916-023-02966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084810.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO USA
| | - David A. Chambers
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD USA
| | - Lisa R. Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada
- Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON Canada
| | - Annemarie Edwards
- Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON Canada
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226 Australia
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB 2J2.00 Canada
| | - Bev J. Holmes
- The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - France Legare
- Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC Canada
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Janet E. Squires
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
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Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham ID. Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research. Front Health Serv 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kate Seers
- Warwick Medical School, Faculty of Science, University of Warwick, Coventry, United Kingdom
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mark Embrett
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jiale Hu
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, United Kingdom
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junqiang Zhao
- Centre for Research on Health and Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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McLean RKD, Carden F, Aiken AB, Armstrong R, Bray J, Cassidy CE, Daub O, Di Ruggiero E, Fierro LA, Gagnon M, Hutchinson AM, Kislov R, Kothari A, Kreindler S, McCutcheon C, Reszel J, Scarrow G, Graham ID. Evaluating the quality of research co-production: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Health Res Policy Syst 2023; 21:51. [PMID: 37312190 DOI: 10.1186/s12961-023-00990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Co-production is an umbrella term used to describe the process of generating knowledge through partnerships between researchers and those who will use or benefit from research. Multiple advantages of research co-production have been hypothesized, and in some cases documented, in both the academic and practice record. However, there are significant gaps in understanding how to evaluate the quality of co-production. This gap in rigorous evaluation undermines the potential of both co-production and co-producers. METHODS This research tests the relevance and utility of a novel evaluation framework: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Following a co-production approach ourselves, our team collaborated to develop study objectives, questions, analysis, and results sharing strategies. We used a dyadic field-test design to execute RQ + 4 Co-Pro evaluations amongst 18 independently recruited subject matter experts. We used standardized reporting templates and qualitative interviews to collect data from field-test participants, and thematic assessment and deliberative dialogue for analysis. Main limitations include that field-test participation included only health research projects and health researchers and this will limit perspective included in the study, and, that our own co-production team does not include all potential perspectives that may add value to this work. RESULTS The field test surfaced strong support for the relevance and utility of RQ + 4 Co-Pro as an evaluation approach and framework. Research participants shared opportunities for fine-tuning language and criteria within the prototype version, but also, for alternative uses and users of RQ + 4 Co-Pro. All research participants suggested RQ + 4 Co-Pro offered an opportunity for improving how co-production is evaluated and advanced. This facilitated our revision and publication herein of a field-tested RQ + 4 Co-Pro Framework and Assessment Instrument. CONCLUSION Evaluation is necessary for understanding and improving co-production, and, for ensuring co-production delivers on its promise of better health.. RQ + 4 Co-Pro provides a practical evaluation approach and framework that we invite co-producers and stewards of co-production-including the funders, publishers, and universities who increasingly encourage socially relevant research-to study, adapt, and apply.
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Affiliation(s)
- Robert K D McLean
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
- Policy and Evaluation Division, International Development Research Centre, Ottawa, Canada.
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada.
| | | | - Alice B Aiken
- Vice-President Research and Innovation, Dalhousie University, Halifax, Canada
| | - Rebecca Armstrong
- Research and Evaluation Branch, National Disability Insurance Agency, Melbourne, Australia
| | - Judy Bray
- Vice-President Research, Canadian Cancer Society, Toronto, Canada
| | | | - Olivia Daub
- School of Communication Sciences & Disorders, University of Western Ontario, London, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Leslie A Fierro
- Max Bell School of Public Policy, McGill University, Montreal, Canada
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University, Manchester, United Kingdom
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anita Kothari
- School of Health Studies, Western University, London, Canada
| | - Sara Kreindler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Chris McCutcheon
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Gayle Scarrow
- Michael Smith Health Research B.C, Vancouver, Canada
| | - Ian D Graham
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute & Schools of Epidemiology and Public Health & Nursing, University of Ottawa, Ottawa, Canada
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Nadalin Penno L, Graham ID, Backman C, Davies B, Squires J. The SITS framework: sustaining innovations in tertiary settings. Front Health Serv 2023; 3:1102428. [PMID: 37363733 PMCID: PMC10287174 DOI: 10.3389/frhs.2023.1102428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Background To date, little attention has focused on what the determinants are and how evidence-based practices (EBPs) are sustained in tertiary settings (i.e., acute care hospitals). Current literature reveals several frameworks designed for implementation of EBPs (0-2 years), yet fewer exist for the sustainment of EBPs (>2 years) in clinical practice. Frameworks containing both phases generally list few determinants for the sustained use phase, but rather state ongoing monitoring or evaluation is necessary. Notably, a recent review identified six constructs and related strategies that facilitate sustainment, however, the pairing of determinants and how best to sustain EBPs in tertiary settings over time remains unclear. The aim of this paper is to present an evidence-informed framework, which incorporates constructs, determinants, and knowledge translation interventions (KTIs) to guide implementation practitioners and researchers in the ongoing use of EBPs over time. Methods We combined the results of a systematic review and theory analysis of known sustainability frameworks/models/theories (F/M/Ts) with those from a case study using mixed methods that examined the ongoing use of an organization-wide pain EBP in a tertiary care center (hospital) in Canada. Data sources included peer-reviewed sustainability frameworks (n = 8) related to acute care, semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level, chart audits (n = 200), and document review (n = 29). We then compared unique framework components to the evolving literature and present main observations. Results We present the Sustaining Innovations in Tertiary Settings (SITS) framework which consists of 7 unique constructs, 49 determinants, and 29 related KTIs that influence the sustainability of EBPs in tertiary settings. Three determinants and 8 KTIs had a continuous influence during implementation and sustained use phases. Attention to the level of application and changing conditions over time affecting determinants is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and linking KTIs to target behaviors that incrementally address low adherence rates promotes sustainability. Conclusions The SITS framework provides a novel resource to support future practice and research aimed at sustaining EBPs in tertiary settings and improving patient outcomes. Findings confirm the concept of sustainability is a "dynamic ongoing phase".
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Environment and Health Sciences, Canadore College, North Bay, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
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Plamondon KM, Dixon J, Brisbois B, Pereira RC, Bisung E, Elliott SJ, Graham ID, Ndumbe-Eyoh S, Nixon S, Shahram S. Turning the tide on inequity through systematic equity action-analysis. BMC Public Health 2023; 23:890. [PMID: 37189082 DOI: 10.1186/s12889-023-15709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Collective agreement about the importance of centering equity in health research, practice, and policy is growing. Yet, responsibility for advancing equity is often situated as belonging to a vague group of 'others', or delegated to the leadership of 'equity-seeking' or 'equity-deserving' groups who are tasked to lead systems transformation while simultaneously navigating the violence and harms of oppression within those same systems. Equity efforts also often overlook the breadth of equity scholarship. Harnessing the potential of current interests in advancing equity requires systematic, evidence-guided, theoretically rigorous ways for people to embrace their own agency and influence over the systems in which they are situated. ln this article, we introduce and describe the Systematic Equity Action-Analysis (SEA) Framework as a tool that translates equity scholarship and evidence into a structured process that leaders, teams, and communities can use to advance equity in their own settings. METHODS This framework was derived through a dialogic, critically reflective and scholarly process of integrating methodological insights garnered over years of equity-centred research and practice. Each author, in a variety of ways, brought engaged equity perspectives to the dialogue, bringing practical and lived experience to conversation and writing. Our scholarly dialogue was grounded in critical and relational lenses, and involved synthesis of theory and practice from a broad range of applications and cases. RESULTS The SEA Framework balances practices of agency, humility, critically reflective dialogue, and systems thinking. The framework guides users through four elements of analysis (worldview, coherence, potential, and accountability) to systematically interrogate how and where equity is integrated in a setting or object of action-analysis. Because equity issues are present in virtually all aspects of society, the kinds of 'things' the framework could be applied to is only limited by the imagination of its users. It can inform retrospective or prospective work, by groups external to a policy or practice setting (e.g., using public documents to assess a research funding policy landscape); or internal to a system, policy, or practice setting (e.g., faculty engaging in a critically reflective examination of equity in the undergraduate program they deliver). CONCLUSIONS While not a panacea, this unique contribution to the science of health equity equips people to explicitly recognize and interrupt their own entanglements in the intersecting systems of oppression and injustice that produce and uphold inequities.
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Affiliation(s)
- Katrina M Plamondon
- Science of Health Equity Learning Lab & Assistant Professor, School of Nursing, University of British Columbia ART360, 1147 Research Road, Kelowna, BC, Canada.
| | - Jenna Dixon
- Science of Health Equity Learning Lab School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Ben Brisbois
- Science of Health Equity Learning Lab at the School of Nursing, School of Health Sciences, University of British Columbia, University of Northern British Columbia, Kelowna, Prince George, BC, BC, Canada
| | | | - Elijah Bisung
- School of Kinesiology & Health Studies, Queens University, Kingston, Canada
| | - Susan J Elliott
- Geography and Environmental Management, University of Waterloo, Ontario, Canada
| | - Ian D Graham
- Centre for Practice-Changing Research, School of Epidemiology & Public Health, Faculty of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sume Ndumbe-Eyoh
- Dalla Lana School of Public Health, Black Health Education Collaborative &, University of Toronto, Toronto, Canada
| | - Stephanie Nixon
- Health Sciences & Director, School of Rehabilitation Therapy, Queens University, Kingston, Canada
| | - Sana Shahram
- Science of Health Equity Learning Lab & Assistant Professor, School of Nursing, University of British Columbia, Columbia, Canada
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Verret M, Fergusson DA, Nicholls SG, Graham M, Zivkovic F, Lê M, Geist A, Lam NH, Graham ID, Turgeon AF, McIsaac DI, Lalu MM. Engaging patients in anesthesiology research: a rewarding frontier. Can J Anaesth 2023; 70:817-823. [PMID: 36959493 PMCID: PMC10241667 DOI: 10.1007/s12630-023-02432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 03/25/2023] Open
Affiliation(s)
- Michael Verret
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada.
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Megan Graham
- Patient partner, The Ottawa Hospital, Ottawa, ON, Canada
| | - Fiona Zivkovic
- Patient partner, The Ottawa Hospital, Ottawa, ON, Canada
| | - Maxime Lê
- Patient partner, The Ottawa Hospital, Ottawa, ON, Canada
| | - Allison Geist
- Patient partner, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nhat Hung Lam
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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Santos WJ, Hutchinson AM, Rader T, Graham ID, Watkins V, Candido LKD, Greenough M, Squires JE. Insights from using an outcomes measurement properties search filter and conducting citation searches to locate psychometric articles of tools used to measure context attributes. BMC Res Notes 2023; 16:34. [PMID: 36906571 PMCID: PMC10007786 DOI: 10.1186/s13104-023-06294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/20/2023] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVES To describe our experience with using a methodological outcomes measurement search filter (precise and sensitive versions of a filter designed to locate articles that report on psychometric properties of measurement tools) and citation searches to locate psychometric articles for tools that can be used to measure context attributes. To compare the precise filter when used alone and with reference list checking to citation searching according to number of records found, precision, and sensitivity. RESULTS Using the precise filter, we located 130 of 150 (86.6%) psychometric articles related to 22 of 31 (71.0%) tools that potentially measured an attribute of context. In a subset of six tools, the precise filter alone was more precise than searching with the precise filter combined with reference list searching, or citation searching alone. The precise filter combined with reference list checking was the most sensitive search method examined. Overall, we found the precise filter helpful for our project as it decreased record screening time. For non-patient reported outcomes tools, we had less success with locating psychometric articles using the precise filter because some psychometric articles were not indexed in PubMed. More research that systematically evaluates database searching methods is needed to validate our findings.
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Affiliation(s)
- Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alison M. Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - Ian D. Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Vanessa Watkins
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Megan Greenough
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Janet E. Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
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MacLeod MLP, McCaffrey G, Wilson E, Zimmer LV, Snadden D, Zimmer P, Jónatansdóttir S, Fyfe TM, Koopmans E, Ulrich C, Graham ID. Exploring the intersection of hermeneutics and implementation: a scoping review. Syst Rev 2023; 12:30. [PMID: 36864488 PMCID: PMC9979573 DOI: 10.1186/s13643-023-02176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices. METHODS We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components. RESULTS Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation. CONCLUSIONS Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation. TRIAL REGISTRATION The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.
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Affiliation(s)
- Martha L P MacLeod
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada. .,Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Graham McCaffrey
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Lela V Zimmer
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David Snadden
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada.,Northern Medical Program, Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Peter Zimmer
- University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Steinunn Jónatansdóttir
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Trina M Fyfe
- Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada.,Geoffrey R. Weller Library, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Cathy Ulrich
- Northern Health Authority, Prince George, British Columbia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Hartley T, Soubry É, Acker M, Osmond M, Couse M, Gillespie MK, Ito Y, Marshall AE, Lemire G, Huang L, Chisholm C, Eaton AJ, Price EM, Dowling JJ, Ramani AK, Mendoza-Londono R, Costain G, Axford MM, Szuto A, McNiven V, Damseh N, Jobling R, de Kock L, Mojarad BA, Young T, Shao Z, Hayeems RZ, Graham ID, Tarnopolsky M, Brady L, Armour CM, Geraghty M, Richer J, Sawyer S, Lines M, Mercimek-Andrews S, Carter MT, Graham G, Kannu P, Lazier J, Li C, Aul RB, Balci TB, Dlamini N, Badalato L, Guerin A, Walia J, Chitayat D, Cohn R, Faghfoury H, Forster-Gibson C, Gonorazky H, Grunebaum E, Inbar-Feigenberg M, Karp N, Morel C, Rusnak A, Sondheimer N, Warman-Chardon J, Bhola PT, Bourque DK, Chacon IJ, Chad L, Chakraborty P, Chong K, Doja A, Goh ESY, Saleh M, Potter BK, Marshall CR, Dyment DA, Kernohan K, Boycott KM. Bridging clinical care and research in Ontario, Canada: Maximizing diagnoses from reanalysis of clinical exome sequencing data. Clin Genet 2023; 103:288-300. [PMID: 36353900 DOI: 10.1111/cge.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
We examined the utility of clinical and research processes in the reanalysis of publicly-funded clinical exome sequencing data in Ontario, Canada. In partnership with eight sites, we recruited 287 families with suspected rare genetic diseases tested between 2014 and 2020. Data from seven laboratories was reanalyzed with the referring clinicians. Reanalysis of clinically relevant genes identified diagnoses in 4% (13/287); four were missed by clinical testing. Translational research methods, including analysis of novel candidate genes, identified candidates in 21% (61/287). Of these, 24 families have additional evidence through data sharing to support likely diagnoses (8% of cohort). This study indicates few diagnoses are missed by clinical laboratories, the incremental gain from reanalysis of clinically-relevant genes is modest, and the highest yield comes from validation of novel disease-gene associations. Future implementation of translational research methods, including continued reporting of compelling genes of uncertain significance by clinical laboratories, should be considered to maximize diagnoses.
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Affiliation(s)
- Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Élisabeth Soubry
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Meryl Acker
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Yoko Ito
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Aren E Marshall
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Gabrielle Lemire
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Lijia Huang
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Alison J Eaton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- University of Alberta, Edmonton, Canada
| | - E Magda Price
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - James J Dowling
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Gregory Costain
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Michelle M Axford
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Anna Szuto
- Hospital for Sick Children, Toronto, Canada
| | - Vanda McNiven
- Hospital for Sick Children, Toronto, Canada
- University Health Network, Toronto, Canada
| | | | | | - Leanne de Kock
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Ted Young
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Zhuo Shao
- University of Toronto, Toronto, Canada
- North York General Hospital, Toronto, Canada
| | | | - Ian D Graham
- University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Christine M Armour
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Julie Richer
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sarah Sawyer
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Matthew Lines
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Melissa T Carter
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Gail Graham
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Peter Kannu
- Hospital for Sick Children, Toronto, Canada
- University of Alberta, Edmonton, Canada
| | - Joanna Lazier
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Chumei Li
- McMaster Children's Hospital, Hamilton, Canada
| | - Ritu B Aul
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Tugce B Balci
- London Health Sciences Center, Western University, London, Canada
| | | | - Lauren Badalato
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Andrea Guerin
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Jagdeep Walia
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - David Chitayat
- Hospital for Sick Children, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | | | | | | | | | | | | | - Natalya Karp
- London Health Sciences Center, Western University, London, Canada
| | | | - Alison Rusnak
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | | | - Jodi Warman-Chardon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
| | - Priya T Bhola
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Danielle K Bourque
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Lauren Chad
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Asif Doja
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Maha Saleh
- London Health Sciences Center, Western University, London, Canada
| | | | - Beth K Potter
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Christian R Marshall
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - David A Dyment
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin Kernohan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
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Aravind G, Graham ID, Cameron JI, Ploughman M, Salbach NM. Conditions and strategies influencing sustainability of a community-based exercise program incorporating a healthcare-community partnership for people with balance and mobility limitations in Canada: A collective case study of the Together in Movement and Exercise (TIME™) program. Front Rehabil Sci 2023; 4:1064266. [PMID: 36923967 PMCID: PMC10009252 DOI: 10.3389/fresc.2023.1064266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/25/2023] [Indexed: 03/02/2023]
Abstract
Background Community-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time. Purpose To identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers. Methods Using a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences. Results Twenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation. Conclusion Sustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, Centre for Practice Changing Research, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Michelle Ploughman
- BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Nancy M. Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
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35
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Squires JE, Santos WJ, Graham ID, Brehaut J, Curran JA, Francis JJ, Grimshaw JM, Hillmer M, Ivers N, Lavis J, Michie S, Noseworthy T, Hutchinson AM. Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Response to Recent Commentaries. Int J Health Policy Manag 2023; 12:7908. [PMID: 37579435 PMCID: PMC10125086 DOI: 10.34172/ijhpm.2023.7908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/18/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Janet E. Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian D. Graham
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Janet A. Curran
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Jill J. Francis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michael Hillmer
- Ontario Ministry of Health and LongTerm Care, Toronto, ON, Canada
| | - Noah Ivers
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Toronto, ON, Canada
| | - John Lavis
- 0Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Thomas Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Alison M. Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Tricco AC, Nincic V, Darvesh N, Rios P, Khan PA, Ghassemi MM, MacDonald H, Yazdi F, Lai Y, Warren R, Austin A, Cleary O, Baxter NN, Burns KEA, Coyle D, Curran JA, Graham ID, Hawker G, Légaré F, Watt J, Witteman HO, Clark JP, Bourgeault IL, Parsons Leigh J, Ahmed SB, Lawford K, Aiken AB, Langlois EV, McCabe C, Shepperd S, Skidmore B, Pattani R, Leon N, Lundine J, Adisso ÉL, El-Adhami W, Straus SE. Global evidence of gender equity in academic health research: a scoping review. BMJ Open 2023; 13:e067771. [PMID: 36792322 PMCID: PMC9933760 DOI: 10.1136/bmjopen-2022-067771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To chart the global literature on gender equity in academic health research. DESIGN Scoping review. PARTICIPANTS Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER Open Science Framework: https://osf.io/8wk7e/.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marco M Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rachel Warren
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alyssa Austin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olga Cleary
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Nancy N Baxter
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Melbourne, Australia
| | - Karen E A Burns
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- HEI, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet A Curran
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - France Légaré
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Holly O Witteman
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
- Office of Education and Professional Development, Université Laval, Quebec City, Québec, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Lancet Ltd, London, London, UK
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Lawford
- Department of Gender Studies, Queen's University, Haudenosaunee and Anishinaabek Territories, Settlement of Kingston, Ontario, Canada
| | - Alice B Aiken
- Department of Research and Innovation, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), WHO, Geneve, Switzerland
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, Alberta, Canada
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Reena Pattani
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Internal Medicine, Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec City, Quebec, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Canberra, ACT, Australia
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
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McIntyre LA, Fergusson DA, McArdle T, Fox-Robichaud A, English SW, Martin C, Marshall J, Cook DJ, Graham ID, Hawken S, McCartney C, Menon K, Saginur R, Seely A, Stiell I, Thavorn K, Weijer C, Iyengar A, Muscedere J, Forster AJ, Taljaard M. FLUID trial: a hospital-wide open-label cluster cross-over pragmatic comparative effectiveness randomised pilot trial comparing normal saline to Ringer's lactate. BMJ Open 2023; 13:e067142. [PMID: 36737087 PMCID: PMC9900065 DOI: 10.1136/bmjopen-2022-067142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Normal saline (NS) and Ringer's lactate (RL) are the most common crystalloids used for fluid therapy. Despite evidence of possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function and death), few large multi-centre randomised trials have evaluated the effect of these fluids on clinically important outcomes. We conducted a pilot trial to explore the feasibility of a large trial powered for clinically important outcomes. DESIGN FLUID was a pragmatic pilot cluster randomised cross-over trial. SETTING Four hospitals in the province of Ontario, Canada PARTICIPANTS: All hospitalised adult and paediatric patients with an incident admission to the hospital over the course of each study period. INTERVENTIONS A hospital wide policy/strategy which stocked either NS or RL throughout the hospital for 12 weeks before crossing over to the alternate fluid for the subsequent 12 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES The primary feasibility outcome was study fluid protocol adherence. Secondary feasibility outcomes included time to Research Ethics Board (REB) approval and trial initiation. Primary (composite of death or re-admission to hospital in first 90 days of index hospitalisation) and secondary clinical outcomes were analysed descriptively. RESULTS Among 24 905 included patients, mean age 59.1 (SD 20.5); 13 977 (56.1%) were female and 21 150 (85.0%) had medical or surgical admitting diagnoses. Overall, 96 821 L were administered in the NS arm, and 78 348 L in the RL arm. Study fluid adherence to NS and RL was 93.7% (site range: 91.6%-98.0%) and 79.8% (site range: 72.5%-83.9%), respectively. Time to REB approval ranged from 2 to 48 days and readiness for trial initiation from 51 to 331 days. 5544 (22.3%) patients died or required hospital re-admission in the first 90 days. CONCLUSIONS The future large trial is feasible. Anticipating and addressing logistical challenges during the planning stages will be imperative. TRIAL REGISTRATION NUMBER NCT02721485.
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Affiliation(s)
- Lauralyn Ann McIntyre
- Department of Medicine (Critical Care), Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Critical Care, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tracy McArdle
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Shane W English
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), London Health Sciences Centre, London, Ontario, Canada
| | - John Marshall
- Surgery/Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Hawken
- ICES @uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colin McCartney
- Anesthesiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Kusum Menon
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Raphael Saginur
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Seely
- Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ian Stiell
- Department of Emergency Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles Weijer
- Rotman Institute of Philospohy, Western University Faculty of Science, London, Ontario, Canada
| | - Akshai Iyengar
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Muscedere
- Critical Care, Kingston General Hospital, Kingston, Ontario, Canada
| | - Alan J Forster
- Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Grinspun D, Wallace K, Li SA, McNeill S, Squires JE, Bujalance J, D'Arpino M, De Souza G, Farshait N, Gabbay J, Graham ID, Hutchinson A, Kinder K, Laur C, Mah T, Moore JE, Plant J, Ploquin J, Ruiter PJA, St-Germain D, Sills-Maerov M, Tao M, Titler M, Zhao J. Corrigendum to “Exploring social movement concepts and actions in a knowledge uptake and sustainability context: A concept analysis” [Int J Nurs Sci 9/4 (2022) 411–421]. Int J Nurs Sci 2023; 10:e1. [PMID: 37128483 PMCID: PMC10148247 DOI: 10.1016/j.ijnss.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.ijnss.2022.08.003.].
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Bhuiya AR, Makarski J, Hayden L, Perrier L, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Ritchie LMP, Squires J, Rac V, Fahim C, Kastner M. Identifying candidate quality indicators of tools that support the practice of knowledge translation: a scoping review protocol. JBI Evid Synth 2023; 21:264-278. [PMID: 36111878 DOI: 10.11124/jbies-22-00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and characterize relevant knowledge translation methods tools (those that provide guidance for optimized knowledge translation practice) to uncover candidate quality indicators to inform a future quality assessment tool for knowledge translation strategies. INTRODUCTION Knowledge translation strategies (defined as including knowledge translation interventions, tools, and products) target various knowledge users, including patients, clinicians, researchers, and policy-makers. The development and use of strategies that support knowledge translation practice have been rapidly increasing, making it difficult for knowledge users to decide which to use. There is limited evidence-based guidance or measures to help assess the overall quality of knowledge translation strategies. INCLUSION CRITERIA Empirical and non-empirical documents will be considered if they explicitly describe a knowledge translation methods tool and its development, evaluation or validation, methodological strengths or limitations, and/or use over time. The review will consider a knowledge translation methods tool if it falls within at least one knowledge translation domain (ie, implementation, dissemination, sustainability, scalability, integrated knowledge translation) in the health field. METHODS We will conduct a systematic search of relevant electronic databases and gray literature. The search strategy will be developed iteratively by an experienced medical information specialist and peer-reviewed with the PRESS checklist. The search will be limited to English-only documents published from 2005 onward. Documents will be independently screened, selected, and extracted by 2 researchers. Data will be analyzed and summarized descriptively, including the characteristics of the included documents, knowledge translation methods tools, and candidate quality indicators. SCOPING REVIEW REGISTRATION Open Science Framework ( https://osf.io/chxvq ).
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Leigh Hayden
- Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- University Health Network, Toronto, ON, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Fok-Han Leung
- St Michael's Hospital, Unity Health, Tornoto, ON, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Valeria Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,North York General Hospital, Research and Innovation, North York, ON, Canada
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Carroll K, Hudek N, Bénard A, Presseau J, Richards DP, Susan M, Fergusson DA, Graham ID, Mestre TA, Brehaut JC. Supporting Trial Participation in People with the Huntington's Gene: A Patient-Centered, Theory-Guided Survey of Barriers and Enablers. J Huntingtons Dis 2022; 11:421-434. [PMID: 36155526 DOI: 10.3233/jhd-220541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Under-recruitment regularly impedes clinical trials, leading to wasted resources and opportunity costs. Methods for designing trial participation strategies rarely consider behavior change theory. OBJECTIVE Informed by the Theoretical Domains Framework, we identified factors important to participating in Huntington's disease research and provide examples of how such a theory-informed approach can make specific suggestions about how to design targeted recruitment strategies. METHODS We identified a range of trial participation barriers and enablers based on interviews of key informants and implemented an online survey of members of the Huntington's disease community, asking them to rate the extent to which different factors would affect likelihood to participate in a generic Huntington's disease trial. RESULTS From 4,195 members, we received 323 responses and 243 completed surveys (323/4,195 or 8% participation, 243/323 or 75% completion). Respondents endorsed 9 barriers and 23 enablers relevant to trial participation. Most frequently endorsed barriers were travel to the study site (69%), worry about unknown side effects (65%), trial documents being difficult to understand (64%), and participation affecting other activities (49%). Enablers included optimism about likelihood of trial participation leading to a cure (98%), helping others (98%), contributing to science (97%), and having helpful people available to help with the participation decision (89%). CONCLUSION Our theory-informed survey to identify barriers to and enablers of Huntington's disease trial participation identified 32 factors, from 13 theoretical domains relevant to trial participation, and suggests effective approaches for improving trial participation and patient experience.
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Affiliation(s)
- Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada
| | - Natasha Hudek
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada
| | - Angèle Bénard
- Huntington Society of Canada (HSC), Waterloo, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Marlin Susan
- Clinical Trials Ontario, MaRS Centre, Toronto, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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41
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Mrklas KJ, Merali S, Khan M, Shergill S, Boyd JM, Nowell L, Pfadenhauer LM, Paul K, Goertzen A, Swain L, Sibley KM, Vis-Dunbar M, Hill MD, Raffin-Bouchal S, Tonelli M, Graham ID. How are health research partnerships assessed? A systematic review of outcomes, impacts, terminology and the use of theories, models and frameworks. Health Res Policy Syst 2022; 20:133. [DOI: 10.1186/s12961-022-00938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual, psychometric and pragmatic characteristics, could improve the quantification, measurement and reporting partnership outcomes and impacts. This cascading review was undertaken as part of a coordinated, multicentre effort to identify, synthesize and assess a vast body of health research partnership literature.
Objective
To systematically assess the outcomes and impacts of health research partnerships, relevant terminology and the type/use of theories, models and frameworks (TMF) arising from studies using partnership assessment tools with known conceptual, psychometric and pragmatic characteristics.
Methods
Four electronic databases were searched (MEDLINE, Embase, CINAHL Plus and PsycINFO) from inception to 2 June 2021. We retained studies containing partnership evaluation tools with (1) conceptual foundations (reference to TMF), (2) empirical, quantitative psychometric evidence (evidence of validity and reliability, at minimum) and (3) one or more pragmatic characteristics. Outcomes, impacts, terminology, definitions and TMF type/use were abstracted verbatim from eligible studies using a hybrid (independent abstraction–validation) approach and synthesized using summary statistics (quantitative), inductive thematic analysis and deductive categories (qualitative). Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).
Results
Application of inclusion criteria yielded 37 eligible studies. Study quality scores were high (mean 80%, standard deviation 0.11%) but revealed needed improvements (i.e. methodological, reporting, user involvement in research design). Only 14 (38%) studies reported 48 partnership outcomes and 55 impacts; most were positive effects (43, 90% and 47, 89%, respectively). Most outcomes were positive personal, functional, structural and contextual effects; most impacts were personal, functional and contextual in nature. Most terms described outcomes (39, 89%), and 30 of 44 outcomes/impacts terms were unique, but few were explicitly defined (9, 20%). Terms were complex and mixed on one or more dimensions (e.g. type, temporality, stage, perspective). Most studies made explicit use of study-related TMF (34, 92%). There were 138 unique TMF sources, and these informed tool construct type/choice and hypothesis testing in almost all cases (36, 97%).
Conclusion
This study synthesized partnership outcomes and impacts, deconstructed term complexities and evolved our understanding of TMF use in tool development, testing and refinement studies. Renewed attention to basic concepts is necessary to advance partnership measurement and research innovation in the field.
Systematic review protocol registration: PROSPERO protocol registration: CRD42021137932 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137932.
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Chen W, Modanloo S, Graham ID, Hu J, Lewis KB, Gifford W. A mixed-methods systematic review of interventions to improve leadership competencies of managers supervising nurses. J Nurs Manag 2022; 30:4156-4211. [PMID: 36194186 DOI: 10.1111/jonm.13828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023]
Abstract
AIM This study aimed to synthesize evidence on interventions to improve leadership competencies of managers supervising nurses. BACKGROUND In recent years, numerous interventions have been developed to improve the leadership competencies of managers supervising nurses. However, researchers and nursing leaders are unclear about what aspects of interventions are effective for developing which competencies. METHODS We conducted a mixed-methods systematic review following the Joanna Briggs Institute (JBI) approach for evidence synthesis. The Medline (Ovid), CINAHL, Embase, Scopus, Nursing and Allied Health Database were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 69 studies (35 quantitative, 22 mixed methods, 12 qualitative) evaluating 68 interventions were included. Studies showed that interventions used modal activities such as lectures, group work and mentoring that generally had positive effects on improving leadership competencies such as supporting, developing and recognizing nurses. Opportunities to interact with peers increased managers' engagement in the interventions; however, many barriers existed for managers to use the competencies in practice including understaffing, insufficient time and lack of support from supervisors and staff. CONCLUSIONS Leadership interventions were shown to have beneficial effects on developing different competencies. Managers predominately felt positive about participating in leadership interventions; however, they expressed many difficulties applying what they learned in practice. IMPLICATIONS FOR NURSING MANAGEMENT Leadership interventions should include multimodal activities that give managers opportunities for interaction. When considering interventions for developing the leadership of managers, it is imperative to consider the practice environments for managers to be successful in applying the competencies they learned in practice.
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Affiliation(s)
- Wenjun Chen
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Shokoufeh Modanloo
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Ian D Graham
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epodemiology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Wilson M, Thavorn K, Hawrysh T, Graham ID, Atkins H, Kekre N, Coyle D, Lalu MM, Fergusson DA, Chan KKW, Ollendorf DA, Presseau J. Engaging Patients and Caregivers in an Early Health Economic Evaluation: Discerning Treatment Value Based on Lived Experience. Pharmacoeconomics 2022; 40:1119-1130. [PMID: 36071263 DOI: 10.1007/s40273-022-01180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Traditionally, economic evaluations have engaged clinicians and policymakers; however, patients and their caregivers have insight that can ensure that the economic evaluation process appropriately reflects disease consequences and adequately addresses their priorities related to treatment. OBJECTIVE We aimed to identify patient priorities to inform an early economic evaluation of chimeric antigen receptor T-cell therapy for adults with relapsed or refractory B-cell acute lymphoblastic leukemia. METHODS We conducted two online group discussions of four participants each, involving patients with experience of hematological cancer and a caregiver. We used an adapted version of the nominal group technique, a consensus-building discussion approach, to generate focused qualitative data. RESULTS Patients and a caregiver acknowledged both the costs directly related to clinical care, such as the out-of-pocket cost of drugs, and the indirect treatment costs, such as the cost of transport, accommodation, and food. The emotional and physical toll of treatment and the influence of treatment on employment and education were additional costs emphasized by participants. Treatment benefits prioritized by participants included the efficacy of treatment, manageable side effects, improved quality of life, accessibility of treatment, and short treatment duration. CONCLUSIONS Engaging patients and caregivers in an early economic evaluation could help identify additional costs and benefits of therapies that are not typically recognized in economic evaluations but have the potential to increase the commercial viability of novel therapies. This research also demonstrates how patients and caregivers can be engaged at different levels in the development of early economic evaluation models.
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Affiliation(s)
- Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | | | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Harold Atkins
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Transplant and Cell Therapy Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kelvin K W Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Bucknall TK, Considine J, Harvey G, Graham ID, Rycroft-Malone J, Mitchell I, Saultry B, Watts JJ, Mohebbi M, Bohingamu Mudiyanselage S, Lotfaliany M, Hutchinson A. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration. BMJ Qual Saf 2022; 31:818-830. [PMID: 35450936 PMCID: PMC9606509 DOI: 10.1136/bmjqs-2021-013785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses' vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses' CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (-2.18 days, 95% CI (-3.53 to -0.82)). CONCLUSION Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000544471p.
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Affiliation(s)
- Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University College of Nursing and Health Sciences, Bedford Park, South Australia, Australia
| | - Ian D Graham
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- School of Epidemiology and Public Health and School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Imogen Mitchell
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Bridey Saultry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mojtaba Lotfaliany
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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Meulenkamp B, Woolnough T, Cheng W, Stacey D, Richards M, Gupta A, Fergusson D, Graham ID. What is the Best Evidence to Guide Management of Acute Achilles Tendon Ruptures? A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Foot & Ankle Orthopaedics 2022. [DOI: 10.1177/2473011421s00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Category: Sports; Trauma Introduction/Purpose: Uncertainty exists regarding the best treatment for acute Achilles tendon ruptures. Simultaneous comparison of the multiple treatment options using traditional study designs is problematic; multiarm clinical trials often are logistically constrained to small sample sizes, and traditional meta-analyses are limited to comparisons of only two treatments that have been compared in head-to-head trials. Network meta-analyses allow for simultaneous comparison of all existing treatments utilizing both direct and indirect evidence. We performed a network meta-analysis of randomized controlled trials to answer the following questions: Considering open repair, minimally invasive surgery repair, functional rehabilitation, or primary immobilization for acute Achilles tendon ruptures, (1) which intervention is associated with the lowest risk of rerupture? (2) Which intervention is associated with the lowest risk of complications resulting in surgery? Methods: Five databases and grey literature sources were searched from inception to September 30, 2019. Included studies were RCTs comparing treatment of acute Achilles tendon ruptures using two or more of the following interventions: primary immobilization, functional rehabilitation, open surgical repair, or MIS repair. We excluded studies enrolling patients with chronic ruptures, reruptures, and preexisting Achilles tendinopathy as well as studies with more than 20% loss to follow-up or less than 6 months of follow-up. Nineteen RCTs (1316 patients) were included in the final analysis. The mean number of patients per study treatment arm was 35 +- 16, mean age was 41 +- 5 years, mean sex composition was 80% +- 10% males, and mean follow-up was 22 +- 12 months. The four treatment groups were compared for the main outcomes of rerupture and complications resulting in operation. The analysis was conducted using random-effects Bayesian network meta-analysis with vague priors. Results: Treatment with primary immobilization had a greater risk of rerupture than open surgery (odds ratio 4.06 [95% credible interval {CrI} 1.47 to 11.88]; p < 0.05). There were no other differences between treatments for risk of rerupture. Minimally invasive surgery was ranked first for fewest complications resulting in surgery and was associated with a lower risk of complications resulting in surgery than functional rehabilitation (OR 0.16 [95% CrI 0.02 to 0.90]; p < 0.05), open surgery (OR 0.22 [95% CrI 0.04 to 0.93]; p < 0.05), and primary immobilization (OR < 0.01 [95% CrI < 0.01 to 0.01]; p < 0.05). Risk of complications resulting in surgery was no different between primary immobilization and open surgery (OR 1.46 [95% CrI 0.35 to 5.36]). Data for patient-reported outcome scores and return to activity were inappropriate for pooling secondary to considerable clinical heterogeneity and imprecision associated with small sample sizes. Conclusion: Faced with acute Achilles tendon rupture, patients should be counseled that the risk of rerupture likely is no different across contemporary treatments. Considering the possibly lower risk of complications resulting in surgery associated with MIS repair, patients and surgeons must balance any benefit with the potential risks of MIS techniques. As treatments continue to evolve, consistent reporting of validated patient-reported outcome measures is critically important to facilitate analysis with existing RCT evidence. Infrequent but serious complications such as rerupture and deep infection should be further explored to determine whether meaningful differences exist in specific patient populations.
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Thørrisen MM, Sadeghi T, Bonsaksen T, Graham ID, Aas RW. Working with alcohol prevention in occupational health services: "knowing how" is more important than "knowing that" - the WIRUS OHS study. Addict Sci Clin Pract 2022; 17:54. [PMID: 36183127 PMCID: PMC9526525 DOI: 10.1186/s13722-022-00335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol consumption is a major public health challenge; the majority of employees consume alcohol regularly and a considerable proportion of employees can be characterized as risky drinkers in need of interventions. Occupational health services (OHS) are uniquely positioned for implementing alcohol prevention interventions targeting employees, but rarely do so. Studies have shown that lack of knowledge among OHS personnel is a barrier to alcohol prevention activity. This study aimed to explore OHS personnels' levels of theoretical and practical alcohol knowledge, and whether these two ways of knowing were differentially associated with alcohol prevention activity. METHODS In this cross-sectional study, survey data were collected from 322 OHS personnel in Norway in 2018 (response rate = 53.6%). The survey included variables of two ways of knowing (theoretical and practical) and three types of doing (intervention frequency, conducting individual interventions, and conducting group interventions). Data were analyzed with descriptive statistics, paired sample t-tests, bivariate correlations, and adjusted linear and logistic regression analyses. RESULTS OHS personnel rated their theoretical alcohol knowledge higher than their practical knowledge (η2 = 0.33, p < 0.001). Higher reported levels of practical knowledge were associated with higher intervention frequency (b = 0.39, β = 0.60, p < 0.001) and greater likelihood of conducting individual interventions (OR = 1.60, p < .001) as well as group interventions (OR = 1.84, p < 0.001). Theoretical knowledge was not associated with conducting interventions, and there was no evidence of an interaction between the two ways of knowing in their association with doing. Sensitivity analyses did not indicate clustering effects of OHS personnel being employed within different units. CONCLUSIONS Different ways of knowing about alcohol among OHS personnel were dissimilarly associated with conducting alcohol prevention interventions in occupational health settings. For doing, knowing how seems to be more important than knowing that. Training programs for OHS personnel should emphasize knowledge about how to deal with alcohol-related issues and how to conduct prevention interventions, rather than focus on detrimental effects of alcohol.
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Affiliation(s)
- Mikkel Magnus Thørrisen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway. .,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Talieh Sadeghi
- Work Research Institute, Centre for Welfare and Labour Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Tore Bonsaksen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Department of Health, Faculty of Health Studies, VID Specialized University, Stavanger, Norway
| | - Ian D Graham
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Randi Wågø Aas
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway. .,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
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47
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Grinspun D, Wallace K, Li SA, McNeill S, Squires JE, Bujalance J, D’Arpino M, De Souza G, Farshait N, Gabbay J, Graham ID, Hutchinson A, Kinder K, Laur C, Mah T, Moore JE, Plant J, Ploquin J, Ruiter PJA, St-Germain D, Sills-Maerov M, Tao M, Titler M, Zhao J. Exploring social movement concepts and actions in a knowledge uptake and sustainability context: A concept analysis. Int J Nurs Sci 2022; 9:411-421. [PMID: 36285080 PMCID: PMC9587399 DOI: 10.1016/j.ijnss.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To share a concept analysis of social movement aimed at advancing its application to evidence uptake and sustainability in health-care. Methods We applied Walker and Avant method to clarify the concept of social movement in the context of knowledge uptake and sustainability. Peer-reviewed and grey literature databases were systematically searched for relevant reports that described how social movement action led to evidence-based practice changes in health and community settings. Titles, abstracts and full texts were reviewed independently and in duplicate, resulting in 38 included articles. Results Social movement action for knowledge uptake and sustainability can be defined as individuals, groups, or organizations that, as voluntary and intrinsically motivated change agents, mobilize around a common cause to improve outcomes through knowledge uptake and sustainability. The 10 defining attributes, three antecedents and three consequences that we identified are dynamic and interrelated, often mutually reinforcing each other to fortify various aspects of the social movement. Examples of defining attributes include an urgent need for action, collective action and collective identity. The concept analysis resulted in the development of the Social Movement Action Framework. Conclusions Social movement action can provide a lens through which we view implementation science. Collective action and collective identity – concepts less frequently canvassed in implementation science literature – can lend insight into grassroots approaches to uptake and sustainability. Findings can also inform providers and change leaders on the practicalities of harnessing social movement action for real-world change initiatives. By mobilizing individuals, groups, or organizations through social movement approaches, they can engage as powered change agents and teams that impact the individual, organizational and health systems levels to facilitate knowledge uptake and sustainability.
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Affiliation(s)
- Doris Grinspun
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Katherine Wallace
- Registered Nurses’ Association of Ontario, Toronto, Canada
- Corresponding author.
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Susan McNeill
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Janet Elaine Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | | | | | - John Gabbay
- University of Southampton, Southampton, England, UK
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University Australia, Victoria, Australia
| | - Kim Kinder
- Healthcare Excellence Canada, Ottawa, Canada
| | - Celia Laur
- Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tina Mah
- Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | | | | | | | | | | | | | - May Tao
- Toronto Public Health, Toronto, Canada
| | - Marita Titler
- School of Nursing, University of Michigan, Ann Arbor, United States
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
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Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, Giangregorio L, Gibbs JC, Giguere A, Graham ID, Hankivsky O, Hoens AM, Holroyd-Leduc J, Kelly C, Moore JE, Ponzano M, Sharma M, Sibley KM, Straus S. Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Med Res Methodol 2022; 22:212. [PMID: 35927615 PMCID: PMC9351159 DOI: 10.1186/s12874-022-01682-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective. Methods We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights. Results We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08). Conclusions Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future. Trial registration Open Science Framework Registration: osf.io/qgh64. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01682-x.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | | | - Cole Etherington
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Olena Hankivsky
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Malika Sharma
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Squires JE, Hutchinson AM, Coughlin M, Bashir K, Curran J, Grimshaw JM, Dorrance K, Aloisio L, Brehaut J, Francis JJ, Ivers N, Lavis J, Michie S, Hillmer M, Noseworthy T, Vine J, Graham ID. Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis. Int J Health Policy Manag 2022; 11:1373-1390. [PMID: 34060269 PMCID: PMC9808341 DOI: 10.34172/ijhpm.2021.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Context is recognized as important to successful knowledge translation (KT) in health settings. What is meant by context, however, is poorly understood. The purpose of the current study was to elicit tacit knowledge about what is perceived to constitute context by conducting interviews with a variety of health system stakeholders internationally so as to compile a comprehensive list of contextual attributes and their features relevant to KT in healthcare. METHODS A descriptive qualitative study design was used. Semi-structured interviews were conducted with health system stakeholders (change agents/KT specialists and KT researchers) in four countries: Australia, Canada, the United Kingdom, and the United States. Interview transcripts were analyzed using inductive thematic content analysis in four steps: (1) selection of utterances describing context, (2) coding of features of context, (3) categorizing of features into attributes of context, (4) comparison of attributes and features by: country, KT experience, and role. RESULTS A total of 39 interviews were conducted. We identified 66 unique features of context, categorized into 16 attributes. One attribute, Facility Characteristics, was not represented in previously published KT frameworks. We found instances of all 16 attributes in the interviews irrespective of country, level of experience with KT, and primary role (change agent/KT specialist vs. KT researcher), revealing robustness and transferability of the attributes identified. We also identified 30 new context features (across 13 of the 16 attributes). CONCLUSION The findings from this study represent an important advancement in the KT field; we provide much needed conceptual clarity in context, which is essential to the development of common assessment tools to measure context to determine which context attributes and features are more or less important in different contexts for improving KT success.
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Affiliation(s)
- Janet E. Squires
- Department of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alison M. Hutchinson
- Monash Health, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kainat Bashir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Curran
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jill J. Francis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Noah Ivers
- Women’s College Hospital, Toronto, ON, Canada
| | - John Lavis
- McMaster University, Hamilton, ON, Canada
| | | | - Michael Hillmer
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | | | | | - Ian D. Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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50
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Reszel J, van den Hoek J, Nguyen T, Aravind G, Bayley MT, Bird ML, Edwards K, Eng JJ, Moore JL, Nelson MLA, Ploughman M, Richardson J, Salbach NM, Tang A, Graham ID. The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation. JMIR Form Res 2022; 6:e37189. [PMID: 35904870 PMCID: PMC9377478 DOI: 10.2196/37189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner’s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke.
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Affiliation(s)
- Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Tram Nguyen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kate Edwards
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Moore
- South Eastern Norway Regional Knowledge Translation Center, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN, United States
| | - Michelle L A Nelson
- March of Dimes Canada, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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