Browsing by Author "Hazlewood, Glen"
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Item Embargo A Novel Semi-Automated Approach for Trial Identification and Evaluation of the Certainty of Evidence from Network Meta-Analyses(2024-09-09) Kamso, Mohammed Mujaab; Hazlewood, Glen; Deardon, Rob; Sajobi, Tolulope; Tomlinson, GeorgeThis thesis introduces an innovative approach for the rapid identification of randomized controlled trials (RCTs) and evaluation of the certainty of evidence within the context of a living systematic review and network meta-analysis. The first paper (Chapter 4) describes a living systematic review methodology that incorporates crowd-sourcing, machine learning and a web-based tool to streamline the identification and classification of RCTs, introducing a novel "studification" process to enhance review maintenance. The second paper (Chapter 5) presents a semi-automated method for evaluating the certainty of evidence derived from direct estimates within a Bayesian network meta-analysis framework, adhering to GRADE guidance. The study also addresses the assessment of indirectness at the study-specific level using online tools. The final paper (Chapter 6) extends this methodology to assess the certainty of evidence for indirect and mixed evidence separately. This is achieved through a semi-automated process that utilizes the concept of the contribution matrix to identify the first-order loop, highlighting the primary contributors to indirect estimate. Additionally, in accordance with GRADE recommendations, an automated approach for evaluating imprecision is developed. Overall, this thesis may enhance the efficiency of maintaining a living systematic review, offering a novel approach to semi-automate the evaluation of evidence certainty from Bayesian network meta-analysis models while adhering to GRADE guidelines. Applied to the context of early rheumatoid arthritis, the findings potentially have positive policy implications such as how fast reviews can be done for clinical practice guideline development.Item Open Access The Design and Development, Usability Evaluation and Pilot Testing of a Patient Decision Aid for Individuals with Nonvalvular Atrial Fibrillation Considering Stroke Prevention Therapy in Atrial Fibrillation Management(2021-05-25) Baers, Justin; Caird, Jeff; Wilton, Steve; Davies, Jan; Hazlewood, GlenBackground: Nonvalvular chronic atrial fibrillation (AF) is associated with a fivefold increase in the risk of stroke and accounts for 15-20% of strokes suffered annually by Canadians. This stroke risk can be reduced by 65% with stroke prevention therapies. However, due to the numerous therapeutic options available to patients for stroke prevention therapy in AF management, deciding which therapy is best for them is difficult and complex. The purpose of this program of research was to design, develop and evaluate an interactive, web-based patient decision aid to assist individuals newly diagnosed with AF make informed decisions, in-line with their personal preferences, about stroke prevention therapies. Methods: The approach of the dissertation was systematic, starting with a systematic review and including iterative prototype development and testing, user evaluations and the inclusion of patient and healthcare provider stakeholders. Results: This approach contends with the complexity of developing successful patient decision aids and the necessity for multiple studies and methods. The findings from the studies culminated in a polished decision aid that is consistent with the International Patient Decision Aids Standards’ most recent criteria, facilitates shared decision making between patients and their healthcare providers and is ready for future clinical study. Factors integral to the decision aid’s successful development included: (1) the user-centred design process; (2) its web app format and responsive mobile-first design; (3) personalization of evidence-based risk information for a patient’s self-reported risk factors; (4) the multi-stage formative evaluation that provided recommendations for design improvement and resulted in over 1,000 design changes; and (5) approval from AF and heart rhythm experts. Conclusion: This dissertation describes the end-to-end development and evaluation of an interactive web-based patient decision aid for individuals who are considering stroke prevention therapy for AF. Collectively, the multiple studies in this dissertation establish a foundation for exploring shared decision making between patients and their healthcare providers, contribute significantly to the domain of patient decision aids and set a new standard for future decision aid development. This new standard can be applied to all fields of medicine where patients are able to share in any decision-making necessary for their care.Item Open Access Enhancing the Reproducibility of Health Technology Assessments(2021-12) Wagner, Daniel; Spackman, Eldon; Hazlewood, Glen; Beall, Reed; Bojke, LauraHealth systems around the world depend on Health Technology Assessment (HTA) programs to provide policy guidance on many factors, including value-for-money. To ensure decisions are made with current information, methods of evidence synthesis and economic evaluation are used to inform a continuous process of evidence gathering and decision making. While computers are used in almost every part of this process, the act of updating an existing HTA often involves a duplication of the original effort. The experience of other scientific fields suggests this is attributable to a lack of reproducibility. This refers to the ability to obtain consistent computational results, using the same set of files and processes. The objective of this thesis was to explore how an emphasis on reproducibility can support the effective development and maintenance of HTAs. Satisfaction of this objective required the identification and implementation of computing strategies to enhance the reproducibility of HTAs. A literature review was used to identify techniques for reproducibility which had proven successful in other fields. The identified strategies encouraged the creation of an accurate and complete record of the research process in human and machine-readable formats. These findings were subsequently applied to a case study which redeveloped an existing appraisal of biologic treatment for psoriatic arthritis. The first part of the case study summarized the development and execution of an automated workflow. The second part explored how the computing strategies affected the programming of the economic model. Outcomes from the case study included improved quality control, more efficient updating, and the elimination of barriers to the characterization of uncertainty. With enough investment, enhancing the reproducibility of HTAs will enable improved transparency, better decision making, and ultimately population health gains.Item Open Access “How Are You?” Perspectives of Patients and Healthcare Providers on Using Text-Messaging to Support Care for Patients with Rheumatoid Arthritis(2023-09-14) Zafar, Saania Nawab; Barber, Claire Ellen Hawkins; Hazlewood, Glen; Dempsey, Erika; Then, KarenObjective: Patients with rheumatoid arthritis may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports two-way text-based messaging between patients and their healthcare team. The objective of the present study was to explore perspectives and experiences of healthcare providers (HCPs) and patients regarding the use of text-messaging via WelTel as an adjunct to routine care. Methods: The 6-month WelTel pilot launched in September 2021 with 70 patients enrolled. Patients received monthly “How are you?” text-message check-ins and could message their healthcare team during clinic hours to request health advice. Thirty-nine patients and 21 HCPs were invited to participate in semi-structured interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging the Institute of Medicine Quality framework. Results: Thirteen patients (61.5% female, mean age 62, 10 white) completed interviews. Patients’ views suggested that text-messaging with the rheumatology team supported high quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57% female) completed interviews. HCP perspectives varied dependent on whether they were adopters, partial adopters, or non-adopters of the WelTel platform, with more favorable views reported by adopters. Additional themes reported by HCPs included changes in workload and burnout. Conclusions: This foundational work suggests that patients perceive that adjunct text-messaging based care aids in the provision of high-quality care. Future studies should evaluate the impact on HCP workload and burnout and investigate the effect of texting on patient outcomes.Item Open Access Patient preferences and individualized risk prediction for management of acute coronary syndrome in chronic kidney disease(2021-09-22) Wilson, Todd Allen; James, Matthew; Sajobi, Tolulope; Wilton, Stephen; Hazlewood, GlenChronic kidney disease (CKD) affects over 10% of adult Canadians and is associated with high risks of morbidity and mortality following non-ST-elevation acute coronary syndrome (ACS). ACS is managed invasively or conservatively with medication, however, people with CKD are 20-50% less likely to receive invasive management than patients without CKD. There are important knowledge gaps to support shared decision-making for ACS in this patient population related to risk prediction of clinical outcomes and patient preferences for treatment options. This thesis’ objectives are to: 1) understand patient preferences towards invasive versus conservative management of ACS, 2) develop tools for predicting long-term adverse outcomes following ACS, and 3) estimate net effects of invasive management based on trade-offs in reducing risks of mortality or readmission for myocardial infarction (MI) versus increasing risk of end-stage kidney disease (ESKD). To achieve these objectives, we conducted a discrete choice experiment (DCE) to quantify patient preferences toward treatment decisions for ACS and developed risk prediction models for mortality, readmission for MI, the composite of mortality and readmission for MI, and ESKD. Further, we synthesized patient preference and absolute risk estimates, while incorporating treatment effects from randomized control trials, to conduct a net effect analysis. The DCE found most patients preferred treatment options that lowered their risk of mortality; however, a subgroup of patients was identified with strong preferences toward conservative treatment for ACS. Risk prediction model performance varied. Model calibration was very good; however, discrimination ranged from excellent for predicting ESKD to poor for predicting readmission for MI. The net effect analysis estimated 87% of all patients with CKD were expected to experience net benefit from invasive management with reductions in risks of mortality or readmission for MI outweighing increases in risk of progression to ESKD. This work has addressed knowledge gaps for understanding preferences of patients with CKD toward key attributes of treatment options for ACS and for providing individualized estimates of long-term outcomes according to treatment strategy for ACS for patients with CKD. This work provides knowledge to individualize benefit-harm information and support shared decision-making approaches for ACS treatment for patients with CKD.Item Open Access Patient preferences to value health outcomes in rheumatology clinical trials: Report from the OMERACT special interest group(Oxford University Press, British Society for Rheumatology, 2021-05-24) Thomas, Megan; Fraenkel, Liana; Boonen, Annelies; Bansback, Nick; Buchbinder, Rachelle; Marshall, Deborah; Proulx, Laurie; Voshaar, Marieke; Richards, Pamela; Richards, Dawn P; Hiligsmann, Mickael; Guillemin, Francis; Shea, Beverly; Tugwell, Peter; Hazlewood, GlenObjective. To inform a research plan for future studies by obtaining stakeholder input on the application of preference-based methods to clinical trial design. Methods. We conducted a virtual OMERACT session to encourage stakeholder engagement. We developed materials for the session to facilitate discussion based on identified case examples and feedback sessions. Results. Participants prioritized incorporating patient preferences in all aspects of trial design with an emphasis on outcome selection. Participants highlighted the need for careful consideration around preference heterogeneity and equity factors. Conclusion. Including patient preferences in trial design was considered a priority requiring further exploration to develop comprehensive guidance.Item Open Access Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses(2023-08-02) Tugwell, Peter; Welch, Vivian; Magwood, Olivia; Todhunter-Brown, Alex; Akl, Elie A.; Concannon, Thomas W.; Khabsa, Joanne; Morley, Richard; Schunemann, Holger; Lytvyn, Lyubov; Agarwal, Arnav; Antequera, Alba; Avey, Marc T.; Campbell, Pauline; Chang, Christine; Chang, Stephanie; Dans, Leonila; Dewidar, Omar; Ghersi, Davina; Graham, Ian D.; Hazlewood, Glen; Hilgart, Jennifer; Horsley, Tanya; John, Denny; Jull, Janet; Maxwell, Lara J.; McCutcheon, Chris; Munn, Zachary; Nonino, Francesco; Pardo Pardo, Jordi; Parker, Roses; Pottie, Kevin; Rada, Gabriel; Riddle, Alison; Synnot, Anneliese; Ghogomu, Elizabeth T.; Tomlinson, Eve; Toupin-April, Karine; Petkovic, JenniferAbstract 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.Item Open Access Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation(2020-02-01) Petkovic, Jennifer; Riddle, Alison; Akl, Elie A; Khabsa, Joanne; Lytvyn, Lyubov; Atwere, Pearl; Campbell, Pauline; Chalkidou, Kalipso; Chang, Stephanie M; Crowe, Sally; Dans, Leonila; Jardali, Fadi E; Ghersi, Davina; Graham, Ian D; Grant, Sean; Greer-Smith, Regina; Guise, Jeanne-Marie; Hazlewood, Glen; Jull, Janet; Katikireddi, S. V; Langlois, Etienne V; Lyddiatt, Anne; Maxwell, Lara; Morley, Richard; Mustafa, Reem A; Nonino, Francesco; Pardo, Jordi P; Pollock, Alex; Pottie, Kevin; Riva, John; Schünemann, Holger; Simeon, Rosiane; Smith, Maureen; Stein, Airton T; Synnot, Anneliese; Tufte, Janice; White, Howard; Welch, Vivian; Concannon, Thomas W; Tugwell, PeterAbstract Background Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. Methods This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. Discussion We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.Item Open Access System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002–2019(2022-12-27) Barber, Claire E.; Lacaille, Diane; Croxford, Ruth; Barnabe, Cheryl; Marshall, Deborah A.; Abrahamowicz, Michal; Xie, Hui; Avina-Zubieta, J. A.; Esdaile, John M.; Hazlewood, Glen; Faris, Peter; Katz, Steven; MacMullan, Paul; Mosher, Dianne; Widdifield, JessicaAbstract Objective To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. Methods We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. Results Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67–1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83–0.97). These trends persisted after adjusting for other covariates. Conclusion While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.Item Open Access “The medications are the decision-makers…” Making reproductive and medication use decisions among female patients with rheumatoid arthritis: a constructivist grounded theory(2022-01-22) Rebić, Nevena; Munro, Sarah; Garg, Ria; Hazlewood, Glen; Amiri, Neda; Baldwin, Corisande; Ensworth, Stephanie; Proulx, Laurie; De Vera, Mary A.Abstract Objective To examine how female patients with RA form decisions about having children, pregnancy, and medication use. Methods We employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model. Results We recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system. Conclusion Our framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.Item Open Access “Walking into the unknown…” key challenges of pregnancy and early parenting with inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies(2021-04-21) Rebić, Nevena; Garg, Ria; Ellis, Ursula; Kitchin, Vanessa; Munro, Sarah; Hazlewood, Glen; Amiri, Neda; Bansback, Nick; De Vera, Mary AAbstract Background To conduct a systematic review and thematic synthesis of qualitative studies on the pregnancy and early parenting experiences of patients with inflammatory arthritis (IA). Methods We searched online databases for English-language, qualitative studies capturing the experiences of females with IA or their healthcare providers with pregnancy and/or early parenthood. We extracted findings from included studies and used thematic synthesis to develop descriptive and higher-order analytical themes. Results Of 20 included studies, our analysis identified 5 analytical themes among patients and 3 among providers. Patients’ reproductive desires, the impact of IA on their ability to experience pregnancy, and the availability of information to guide preparedness informed their pregnancy decisions. Patients’ IA management, pregnancy expectations, and access to support influenced their reproductive experiences. Patients’ experiences seeking information and care revealed substantial gaps in reproductive care provision to patients with IA. Reproductive uncertainty related to IA placed a heavy burden on patients’ emotional and psychological wellbeing. Reproductive care provision was influenced by providers’ perceived professional responsibility to address patients’ reproductive goals, fears of negative outcomes, and capacity to harness patient trust, incorporate reproductive care into rheumatology practice and facilitate multi-disciplinary care coordination. Conclusions Our review illuminated several barriers to experiencing pregnancy among patients with IA, particularly related to pregnancy planning support, availability of information, and care coordination among the patient’s healthcare team. To improve care, these barriers may be mitigated through the provision of relevant, practical, and consistent information as well as patient-centred multi-disciplinary approaches for managing pregnancy among patients with IA.