Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis.

BACKGROUND: Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES: 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS: We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA: We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS: Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS: We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS: Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.

The beneficial role of companion animals in translational pain research.

The use of spontaneous painful disease in companion pet animals has been highlighted as one of the changes that could be made to help improve translation of basic science to new therapeutics, acting as a bridge between preclinical and clinical studies, with the goal of accelerating the approval of new therapeutics. This review focuses on the utility of companion pet dogs for translational research by reviewing what outcome measures can be measured, and importantly, the relevance of these outcome measures to human translational research. It also details the practical considerations involved in incorporating companion dogs into human therapeutic development.

Preclinical target validation for non-addictive therapeutics development for pain.

INTRODUCTION: The Helping to End Addiction Long-termSM Initiative supports a wide range of programs to develop new or improved prevention and opioid addiction treatment strategies. An essential component of this effort is to accelerate development of non-opioid pain therapeutics. In all fields of medicine, therapeutics development is an arduous process and late-stage translational efforts such as clinical trials to validate targets are particularly complex and costly. While there are plentiful novel targets for pain treatment, successful clinical validation is rare. It is therefore crucial to develop processes whereby therapeutic targets can be reasonably 'de-risked' prior to substantial late-stage validation efforts. Such rigorous validation of novel therapeutic targets in the preclinical space will give potential private sector partners the confidence to pursue clinical validation of promising therapeutic concepts and compounds. AREAS COVERED: In 2020, the National Institutes of Health (NIH) held the Target Validation for Non-Addictive Therapeutics Development for Pain workshop to gather insights from key opinion leaders in academia, industry, and venture-financing. EXPERT OPINION: The result was a roadmap for pain target validation focusing on three modalities: 1) human evidence; 2) assay development in vitro; 3) assay development in vivo.

Adverse Childhood Experiences (ACEs): Development of an ACEs Knowledge Scale.

BACKGROUND AND PURPOSE: Adverse childhood experiences (ACEs) negatively impacting children's health and later in their lives warrant necessity to educate nursing students about ACEs. The purposes of this study were to evaluate (a) nursing students' understanding of key concepts of ACEs using the ACEs Knowledge Scale (AKS) and (b) psychometric properties of the AKS. METHODS: A survey using AKS was conducted with randomly selected student participants (n = 344) to evaluate students' understanding of ACEs knowledge. Empirical validation of the AKS included content validity using Content Validity Index (CVI), reliability, and construct validity analyses. RESULTS: The results showed students in the Bachelor of Science in Nursing (BSN) program had increased knowledge of ACEs over pre-nursing students, and the BSN graduating students had increased knowledge related to trauma-informed care and building resilience. There were no significant differences in ACEs knowledge between Family Nurse Practitioner (FNP) and BSN students. Evaluation of psychometric properties of AKS revealed S-CVI/Ave=0.912, indicated excellent content validity based on the expert panel's ratings. Cronbach's alpha coefficient = .84 for the overall instrument indicated good reliability. Factor analyses were employed, showing that the 5-factor model gives good fit indexes, supporting the hypothesized factor structure of five key concepts. CONCLUSIONS: The AKS has showed promising implications to future research, nursing education, and nursing practice.

Integration of Adverse Childhood Experiences Across Nursing Curriculum.

Adverse childhood experiences (ACEs) devastate the lives of children, families and the community. Nearly 35 million children in the United States (US) have experienced one or more types of childhood trauma and nearly a third of youth between ages 12 and 17 have experienced two or more traumatic events. Adverse childhood experiences place an economic toll in the U.S., costing between $5.8 billion and $12.6 billion annually. Child maltreatment costs $124 billion, conservatively. Health Professionals play a major role to prevent and effectively intervene in ACEs. To this end, building a nursing workforce with necessary ACEs knowledge is critical as nursing graduates can make a sustainable impact as they translate knowledge in practice to improve health and health outcomes for children, families and communities. This paper describes how a College of Nursing initiated a systematic integration of ACEs knowledge across BSN curriculum from designing an ACEs Curriculum Integration Model, engaging and enabling faculty in the integration process and how ACEs concepts and contents were integrated. Suggestions are made for ongoing work and evaluations of the effects of ACEs curriculum integration.

Adverse Childhood Experiences: Concept Mapping in the Bachelor of Science in Nursing Curriculum.

BACKGROUND: Adverse childhood experiences (ACEs) have deleterious effects on health across the lifespan. Educating health professionals for ACEs awareness and prevention facilitates quality care. Literature documents concept mapping as an effective teaching strategy used in health professions to stimulate learning and foster students' critical thinking. However, ACEs curricular concept mapping remains unexplored. METHOD: Content analysis with manifest coding was used to identify key concepts based on faculty narratives and discussion notes about ACEs content. RESULTS: Major and minor themes emerged to support the ACEs Curricular Concept Map development with direct and indirect paths to culture of health and health equity. CONCLUSIONS: The ACEs Curricular Concept Map was developed to guide teaching ACEs knowledge in a Bachelor of Science in Nursing program. Future studies are needed to evaluate the impact of ACEs curricular concepts on nursing students' learning and graduates' ability to translate knowledge to practice ACEs awareness and prevention toward health equity for all. [J Nurs Educ. 2019;58(4):193-200.].