Browsing by Author "Bansback, Nick"

Now showing 1 - 5 of 5
  • Thumbnail Image
    ItemOpen Access
    An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial
    (2019-02-23) Bansback, Nick; Trenaman, Logan; MacDonald, Karen V; Hawker, Gillian; Johnson, Jeffrey A; Stacey, Dawn; Marshall, Deborah A
    Abstract Background While the rates of total knee arthroplasty (TKA) continue to rise worldwide, there are concerns about whether all surgeries are appropriate. Guidelines for appropriateness suggest that patients should have realistic expectations for total knee arthroplasty (TKA), and that the patient and their surgeon should agree that the potential benefits outweigh the potential harms. The objective of this study is to evaluate whether routinely collected pre- and post-TKA patient-reported outcome measures (PROMs) could be integrated into a patient decision aid to better inform these appropriateness criteria. This randomised trial will evaluate the preliminary efficacy of a tailored PROM-based patient decision aid and surgeon report (compared to usual care) for patients considering TKA on decision quality. Methods This is a pragmatic, randomised controlled trial conducted at one site in Alberta, Canada. Adults over the age of 30 years, who have been scheduled for a TKA consultation at the Edmonton Bone and Joint Centre with a participating surgeon, who understand, speak, and read English, and can provide informed consent, are eligible to participate. Participants will be randomised to receive a PROM-based patient decision aid and surgeon report before their surgical consultation or usual care. The decision aid will provide patients with information on their expected outcomes based on the EQ-5D-5L PROM, and these estimates are individualized based on clinical and demographic characteristics. The primary outcome of this trial is decision quality. Analysis will consider outcomes intention to treat, and feasibility outcomes for implementing the trial to routine practise. Discussion This patient decision aid and surgeon report intervention could contribute to improved treatment decision-making for patients considering total knee arthroplasty. Trial registration (registry and number) ClinicalTrials.gov : NCT03240913. Registered on August 1, 2017.
  • Thumbnail Image
    ItemOpen Access
    Patient Preferences for Disease-modifying Antirheumatic Drug Treatment in Rheumatoid Arthritis: A Systematic Review
    (Journal of Rheumatology, 2020-01) Durand, Caylib; Eldoma, Maysoon; Marshall, Deborah A; Bansback, Nick; Hazlewood, Glen S
    OBJECTIVE: To summarize patients’ preferences for disease modifying anti-rheumatic drug (DMARD) therapy in rheumatoid arthritis (RA). METHODS: We conducted a systematic review to identify English-language studies in adult RA patients that measured patients’ preferences for DMARDs or health states and treatment outcomes relevant to DMARD decisions. Study quality was assessed using a published quality assessment tool. Data on the importance of treatment attributes and associations with patient characteristics was summarized across studies. RESULTS: From 7951 abstracts, we included 36 studies from a variety of countries. Most studies were in patients with established RA and were rated as medium (n=19) or high quality (n=12). The methods to elicit preferences varied, with the most common being discrete choice experiment (DCE) (n=13). Despite the heterogeneity of attributes in DCE studies, treatment benefits (disease improvement) were usually more important than both non-serious (6 of 8 studies), and serious adverse events (5 of 8), and route of administration (7 of 9). Amongst the non-DCE studies, some found patients placed high importance on treatment benefits, while others (in patients with established RA) found patients were quite risk averse. Subcutaneous therapy was often, but not always preferred over intravenous therapy. Patient preferences were variable and commonly associated with sociodemographics. CONCLUSION: Overall, the results showed that many patients place a high value on treatment benefits over other treatment attributes including serious or minor side effects, cost or route of administration. The variability in patient preferences highlights the need to individualize treatment choices in RA.
  • Thumbnail Image
    ItemOpen 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, Glen
    Objective. 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.
  • Thumbnail Image
    ItemOpen Access
    Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices
    (2017-12-06) Howard, Michelle; Bansback, Nick; Tan, Amy; Klein, Doug; Bernard, Carrie; Barwich, Doris; Dodek, Peter; Nijjar, Aman; Heyland, Daren K
    Abstract Background Decisions about care options and the use of life-sustaining treatments should be informed by a person’s values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient’s expressed treatment preference. Methods We conducted a multi-site survey in 20 family practices. Patients aged 50 and older self-completed a questionnaire assessing the importance of eight values (rated 1 to 10), and indicated their preference for use of life-sustaining treatment (5 options). We compared correlations among values to a priori hypotheses based on whether the value related to prolonging or shortening life, and examined expected relationships between importance of values and the preference option for life-sustaining treatment. Results Eight hundred ten patients participated (92% response rate). Of 24 a priori predicted correlations among values statements, 14 were statistically significant but nearly all were negligible in their magnitude and some were in the opposite direction than expected. For example, the correlation between importance of being comfortable and suffering as little as possible and the importance of living as long as possible should have been inversely correlated but was positively correlated (r = 0.08, p = 0.03). Correlations between importance of values items and preference were negligible, ranging from 0.03 to 0.13. Conclusions Patients may not recognize that trade-offs in what is most important may be needed when considering the use of treatments. In the context of preparation for decision-making during serious illness, decision aids that highlight these trade-offs and connect values to preferences more directly may be more helpful than those that do not.
  • Thumbnail Image
    ItemOpen 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 A
    Abstract 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.