Co-construction of health technology assessment recommendations with patients: An example with cardiac defibrillator replacement.

CONTEXT: The National Institute of Excellence in Health and Social Services (INESSS), which functions as the Québec health technology assessment (HTA) agency, tested a new way to engage patients along with health-care professionals in the co-construction of recommendations regarding implantable cardioverter-defibrillator replacement. OBJECTIVE: The objective of this article was to describe the process of co-construction of recommendations and to propose methods of building best practices for patient involvement (PI) in HTA. DESIGN: Throughout the process, documents were collected and participant observations were made. Individual interviews were conducted with patients, health-care professionals and the INESSS scientific team, from January to March 2018. RESULTS: Three committees were established: an expert patient committee to reflect on patient experience literature; an expert health professional committee to reflect on medical literature; and a co-construction committee through which both patients and health-care professionals contributed to develop the recommendations. The expert patients validated and contextualized a literature review produced by the scientific team. This allowed the scientists to consider aspects related to the patient experience and to integrate the feedback from patients into HTA recommendations. The most important factor contributing to a positive PI experience was the structured methodology for selecting patient participants, and a key factor that inhibited the process was a lack of training in PI on the part of the scientific team. CONCLUSIONS: This experience demonstrates that it is possible to co-construct recommendations, even for technically complex HTA subjects, through a more democratic process than usual which led to more patient-focused guidance.

Development of a urinary incontinence educational program using a competency-based approach and case method.

Nurses have limited knowledge about urinary incontinence and find it difficult to care for those who suffer from it, yet there is little training on incontinence designed for nurses. Hence, there is a real need to develop and evaluate an appropriate urinary incontinence educational program. A critical issue is the choice of teaching strategies designed to integrate learning. This article describes the competency-based approach and case method used to develop a urinary incontinence education program.

Effectiveness of a geriatric urinary incontinence educational program for nursing staff.

Incontinence is becoming an increasingly widespread phenomenon. Individuals who suffer from incontinence-related problems, as well as their loved ones, must learn to live with daily situations that are often extremely demanding. In recent years, it has become evident that incontinence can be cured, or at least successfully managed. Many nurses, however, lack sufficient knowledge and skills to intervene appropriately in dealing with problems associated with a lack of bladder control. Therefore, the continence team of the Sherbrooke Geriatric University Institute developed a urinary incontinence educational program for nurses who care for older persons with this problem. An assessment of the impact of this program on nurses' knowledge, intervention skills and attitudes was conducted. A quasi-experimental protocol based on single-group with repeated-measures design was used for this study. A convenience sample was made up of 10 staff members at the Sherbrooke Geriatric University Institute. The study demonstrated a significant improvement in participants' knowledge, skills and attitudes (p=0.005, p=0.005 and p=0.017, respectively). Furthermore, the effects of the program in regard to the acquisition of skills and knowledge by nurses were still evident nine weeks after the program. The value of the present study lies in the development and positive evaluation of a new incontinence educational program for nurses based on a problem-solving approach.