Plastic Surgery, University Health Network, Toronto, Ontario, Canada
Plastic Surgery, University Health Network, Toronto, Ontario, Canada.
BMJ Open. 2021 Aug 30;11(8):e047589. doi: 10.1136/bmjopen-2020-047589.
Major improvements in breast cancer treatment in the last decade include advancements in postmastectomy breast reconstruction (PMBR). Unfortunately, the studies in PMBR are primarily researcher or industry led with minimal input from patients and caregivers. The aim of this study is to use the James Lind Alliance (JLA) approach to bring together the patients, caregivers and clinicians in a priority setting partnership to identify the most important unanswered research questions in PMBR.
The JLA priority setting methodology involved four key stages: gathering research questions on PMBR from patients, caregivers and clinicians; checking these research questions against existing evidence; interim prioritisation and a final consensus meeting to determine the top 10 unanswered research questions using the modified nominal group methodology.
In stage 1, 3168 research questions were submitted from 713 respondents across Canada, of which 73% of the participants were patients or caregivers. Stage 2 confirmed that there were a total of 48 unique unanswered questions. In stage three, 488 individuals completed the interim prioritisation survey and the top 25 questions were taken to a final consensus meeting. In the final stage, the top 10 unanswered research questions were determined. They cover a breadth of topics including personalised surgical treatment, safety of implants and newer techniques, access to PMBR, breast cancer recurrence and rehabilitation.
Identification of the top 10 unanswered research questions is an important first step to generating relevant and impactful research that will ultimately improve the PMBR experience for patients with breast cancer.
过去十年中，乳腺癌治疗取得了重大进展，包括乳房重建术（PMBR）的进步。不幸的是，PMBR 相关研究主要由研究人员或行业主导，患者和护理人员的参与度很低。本研究旨在采用詹姆斯林德联盟（JLA）的方法，将患者、护理人员和临床医生聚集在一个优先事项设定伙伴关系中，以确定 PMBR 中最重要的未解决的研究问题。
JLA 优先事项设定方法包括四个关键阶段：从患者、护理人员和临床医生那里收集有关 PMBR 的研究问题；对照现有证据检查这些研究问题；中期优先排序和最终共识会议，使用修改后的名义群体方法确定前 10 个未解决的研究问题。
在第 1 阶段，从加拿大各地的 713 名受访者中提交了 3168 个研究问题，其中 73%的参与者是患者或护理人员。第 2 阶段证实共有 48 个独特的未回答问题。在第 3 阶段，488 人完成了中期优先排序调查，前 25 个问题被提交给最终共识会议。在最后阶段，确定了前 10 个未回答的研究问题。它们涵盖了广泛的主题，包括个性化手术治疗、植入物和新技术的安全性、PMBR 的可及性、乳腺癌复发和康复。
确定前 10 个未回答的研究问题是生成相关和有影响力的研究的重要第一步，这最终将改善乳腺癌患者的 PMBR 体验。
