Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
University of Calgary, Calgary, Canada.
BMC Musculoskelet Disord. 2023 Sep 14;24(1):734. doi: 10.1186/s12891-023-06877-x.
Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women.
We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care.
We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery.
This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care.
This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
女性受骨关节炎（OA）的影响不成比例，但她们获得早期诊断和管理的机会却比男性少，也不太可能接受针对其需求和偏好的以患者为中心的 OA 护理，尤其是少数族裔女性。支持临床医生优化 OA 护理的一种方法是通过临床指南。我们旨在研究 OA 指南的内容，以指导向包括女性在内的弱势群体提供公平、以患者为中心的护理。
我们在索引数据库和网站上搜索了 2000 年以后由非营利组织发布的英语 OA 相关指南。我们使用直观内容分析来提取数据，并使用汇总统计数据和文本来描述指南的特征、使用六域以患者为中心的护理（PCC）框架的 PCC、按交叉因素的 OA 流行率或障碍，以及改善 OA 护理公平获取的策略。
我们纳入了 2003 年至 2021 年在 8 个地区或国家发表的 36 项 OA 指南。很少（39%）的开发小组有患者参与。虽然大多数（81%）指南包含至少一个 PCC 领域，但指导意见往往简短或模糊，很少涉及交换信息、回应情绪和管理不确定性，也没有提到培养治疗关系。很少（39%）的指南承认或描述了特定群体中 OA 的更高流行率；只有 3 项（8%）提到社会经济地位是 OA 护理的障碍，只有 2 项（6%）为临床医生提供了改善 OA 护理公平获取的指导：评估自我管理干预措施的可接受性、可用性、可及性和可负担性；并使用风险评估工具来识别手术后无法在家中应对的患者。
这项研究表明，OA 指南不能帮助临床医生为因影响获得和护理质量的交叉因素而处于劣势的不同 OA 患者提供护理。开发者可以通过纳入现有的 PCC 指南和公平性指南来加强 OA 指南，这些指南可以从现有的框架和工具中获得，并在指南开发小组中纳入不同的 OA 患者。需要开展未来的研究，以确定可以通过指南或其他方式实施的多层面（患者、临床医生、系统）策略，以改善公平、以患者为中心的 OA 护理。
这项研究得到了一个研究人员、合作者和 13 名有生活经验的不同女性的团队的支持，她们参与了计划，并通过审查研究材料和提供口头（会议期间）和书面（通过电子邮件）反馈来帮助进行数据收集、分析和解释。
