Garfield Sara, Jheeta Seetal, Jacklin Ann, Bischler Anna, Norton Christine, Franklin Bryony D
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
The Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK.
Res Involv Engagem. 2015 Aug 7;1:8. doi: 10.1186/s40900-015-0006-7. eCollection 2015.
There is a consensus that patients and the public should be involved in research in a meaningful way. To date, lay people have been mostly involved in developing research ideas and commenting on patient information but not as much in actual data collection. We have had firsthand experience with lay people helping to conduct a study on how patients in hospital are involved with their medicines. In the first part of this study, we observed doctors' ward rounds, pharmacists' ward visits and nurses' drug administration rounds, to find out if and how healthcare professionals interacted with patients about their medicines. Lay people conducted some of these observations. We wanted to explore the benefits and challenges of having lay people conduct these observations, to tell us more about how lay people can be involved in conducting such research. We interviewed the lay members and researchers involved in this research to find out their views. We also looked at the observation notes to identify what the lay people had noticed that the researchers had not. The lay members and researchers reported that lay members added value to the study by bringing new perspectives. Lay people had noticed some different things to the researchers. We experienced some challenges which need to be addressed. These weregetting the lay observers registered with the hospitals to allow them to be on the wards in this capacitylay observers and researchers having different understanding of research procedures such as patient consenttrying to find lay observers of different backgrounds and ethnic groups.
It is recognised that involving lay people with research in a meaningful rather than tokenistic way is both important and challenging. In a recent health services research study addressing inpatient involvement in medication safety, we sought to overcome this challenge by including lay people in collecting observational data in the hospital setting. The aim of this study was to evaluate lay and researcher perspectives on lay involvement in data collection in order to inform and enhance the future role of lay people in carrying out health services research. We conducted semi-structured interviews with the lay members who collected observational data in our wider study and the researchers who provided support and/or were involved in their recruitment and training. The interviews were transcribed verbatim and coded using open thematic analysis. In addition, we conducted secondary analysis of the observational data to identify the specific contributions of lay observers. We interviewed the three lay members and the four researchers involved. Both these interviews and the secondary data analysis demonstrated that the lay members added value to the study by bringing additional general perspectives on communication with hospital inpatients. Combined with researchers' perspectives on interactions more specifically related to medication, this provided a broader answer to our research question of how healthcare professionals facilitate inpatient understanding of their medication and involvement in medication safety. This contrasted to the involvement lay observers reported having in previous research where their role had been more consultative. The lay members all reported that carrying out the observations had been an interesting and informative experience. Some challenges arose including the infrastructure not having been in place to support this specialist lay research role, differing paradigms of research governance held by the public and researchers in relation to consent procedures and difficulties in recruiting a diverse range of members of the public to carry out the role. Lay members can add value to research by being involved in data collection within health services research. There is a need to build infrastructure to better support this involvement.
人们一致认为患者和公众应以有意义的方式参与研究。迄今为止,外行人大多参与提出研究想法和对患者信息发表评论,但在实际数据收集方面参与较少。我们有外行人协助开展一项关于住院患者如何使用药物的研究的第一手经验。在该研究的第一部分,我们观察了医生的查房、药剂师的病房巡视和护士的给药查房,以了解医护人员是否以及如何就患者的药物与患者进行互动。外行人参与了其中一些观察。我们想探讨让外行人进行这些观察的益处和挑战,以更多地了解外行人如何能够参与开展此类研究。我们采访了参与该研究的外行人成员和研究人员以了解他们的观点。我们还查看了观察记录,以确定外行人注意到但研究人员未注意到的情况。外行人成员和研究人员报告称,外行人成员通过带来新视角为研究增添了价值。外行人注意到了一些与研究人员不同的情况。我们遇到了一些需要解决的挑战。这些挑战包括让外行人观察员在医院登记以便他们能以这种身份进入病房;外行人观察员和研究人员对诸如患者同意等研究程序有不同理解;试图找到不同背景和种族群体的外行人观察员。
人们认识到以有意义而非形式主义的方式让外行人参与研究既重要又具有挑战性。在最近一项关于住院患者参与药物安全的卫生服务研究中,我们试图通过让外行人参与在医院环境中收集观察数据来克服这一挑战。本研究的目的是评估外行人以及研究人员对让外行人参与数据收集的看法,以便为外行人在开展卫生服务研究中的未来角色提供信息并加以完善。我们对在我们更广泛研究中收集观察数据的外行人成员以及提供支持和/或参与其招募与培训的研究人员进行了半结构化访谈。访谈逐字记录并使用开放式主题分析进行编码。此外,我们对观察数据进行了二次分析,以确定外行人观察员的具体贡献。我们采访了三名外行人成员和四名研究人员。这些访谈以及二次数据分析均表明,外行人成员通过对与住院患者沟通带来额外的总体视角为研究增添了价值。结合研究人员对更具体与药物相关互动的看法,这为我们关于医护人员如何促进住院患者对其药物的理解以及参与药物安全的研究问题提供了更广泛的答案。这与外行人观察员报告在先前研究中的参与情况形成对比,在先前研究中他们的角色更多是咨询性的。外行人成员均报告称进行观察是一次有趣且增长见识的经历。出现了一些挑战,包括没有相应的基础设施来支持这种专业的外行人研究角色、公众和研究人员在同意程序方面持有不同的研究治理范式,以及难以招募到各种各样的公众成员来担任这一角色。外行人成员通过参与卫生服务研究中的数据收集可为研究增添价值。需要建立基础设施以更好地支持这种参与。