Pollock Alex, St George Bridget, Fenton Mark, Crowe Sally, Firkins Lester
Research Fellow, Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, UK.
J Health Serv Res Policy. 2014 Jan;19(1):12-8. doi: 10.1177/1355819613500665. Epub 2013 Sep 4.
Equitable involvement of patients and clinicians in setting research and funding priorities is ethically desirable and can improve the quality, relevance and implementation of research. Survey methods used in previous priority setting projects to gather treatment uncertainties may not be sufficient to facilitate responses from patients and their lay carers for some health care topics. We aimed to develop a new model to engage patients and clinicians in setting research priorities relating to life after stroke, and to explore the use of this model within a James Lind Alliance (JLA) priority setting project.
We developed a model to facilitate involvement through targeted engagement and assisted involvement (FREE TEA model). We implemented both standard surveys and the FREE TEA model to gather research priorities (treatment uncertainties) from people affected by stroke living in Scotland. We explored and configured the number of treatment uncertainties elicited from different groups by the two approaches.
We gathered 516 treatment uncertainties from stroke survivors, carers and health professionals. We achieved approximately equal numbers of contributions; 281 (54%) from stroke survivors/carers; 235 (46%) from health professionals. For stroke survivors and carers, 98 (35%) treatment uncertainties were elicited from the standard survey and 183 (65%) at FREE TEA face-to-face visits. This contrasted with the health professionals for whom 198 (84%) were elicited from the standard survey and only 37 (16%) from FREE TEA visits.
The FREE TEA model has implications for future priority setting projects and user-involvement relating to populations of people with complex health needs. Our results imply that reliance on standard surveys may result in poor and unrepresentative involvement of patients, thereby favouring the views of health professionals.
患者和临床医生公平地参与确定研究及资金优先事项,从伦理角度而言是可取的,并且能够提高研究的质量、相关性及实施效果。以往在确定优先事项项目中用于收集治疗不确定性的调查方法,对于某些医疗保健主题而言,可能不足以促使患者及其非专业护理人员做出回应。我们旨在开发一种新模式,让患者和临床医生参与确定与中风后生活相关的研究优先事项,并在詹姆斯·林德联盟(JLA)的优先事项确定项目中探索该模式的应用。
我们开发了一种通过定向参与和辅助参与来促进参与的模式(免费茶点模式)。我们实施了标准调查和免费茶点模式,以从生活在苏格兰的中风患者中收集研究优先事项(治疗不确定性)。我们探讨并整理了两种方法从不同群体中引出的治疗不确定性数量。
我们从中风幸存者、护理人员和卫生专业人员那里收集到了516个治疗不确定性。我们获得的贡献数量大致相等;中风幸存者/护理人员贡献了281个(54%);卫生专业人员贡献了235个(46%)。对于中风幸存者和护理人员,98个(35%)治疗不确定性是通过标准调查引出的,183个(65%)是在免费茶点面对面访问中引出的。这与卫生专业人员形成对比,他们有198个(84%)是通过标准调查引出的,只有37个(16%)是通过免费茶点访问引出的。
免费茶点模式对未来的优先事项确定项目以及与有复杂健康需求人群相关的用户参与具有启示意义。我们的结果表明,依赖标准调查可能导致患者参与度低且缺乏代表性,从而使卫生专业人员的观点占主导。