Patient-centered outcomes research

以患者为中心的结果研究
  • 文章类型: Journal Article
    There is growing recognition that involving patients in the development of new patient-reported outcome measures helps ensure that the outcomes that matter most to people living with health conditions are captured. Here, we describe and discuss different experiences of integrating patients as full patient research partners (PRPs) in outcomes research from multiple perspectives (e.g., researcher, patient, and funder), drawing from three real-world examples. These diverse experiences highlight the strengths, challenges, and impact of partnering with patients to conceptualize, design, and conduct research and disseminate findings. On the basis of our experiences, we suggest basic guidelines for outcomes researchers on establishing research partnerships with patients, including: 1) establishing supportive organizational/institutional policies; 2) cultivating supportive attitudes of researchers and PRPs with recognition that partnerships evolve over time, are grounded in strong communication, and have shared goals; 3) adhering to principles of respect, trust, reciprocity, and co-learning; 4) addressing training needs of all team members to ensure communications and that PRPs are conversant in and familiar with the language and process of research; 5) identifying the resources and advanced planning required for successful patient engagement; and 6) recognizing the value of partnerships across all stages of research. The three experiences presented explore different approaches to partnering; demonstrate how this can fundamentally change the way research work is conceptualized, conducted, and disseminated; and can serve as exemplars for other forms of patient-centered outcomes research. Further work is needed to identify the skills, qualities, and approaches that best support effective patient-researcher partnerships.
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  • 文章类型: Journal Article
    Parkinson disease (PD) is associated with a clinical course of variable duration, severity, and a combination of motor and non-motor features. Recent PD research has focused primarily on etiology rather than clinical progression and long-term outcomes. For the PD patient, caregivers, and clinicians, information on expected clinical progression and long-term outcomes is of great importance. Today, it remains largely unknown what factors influence long-term clinical progression and outcomes in PD; recent data indicate that the factors that increase the risk to develop PD differ, at least partly, from those that accelerate clinical progression and lead to worse outcomes. Prospective studies will be required to identify factors that influence progression and outcome. We suggest that data for such studies is collected during routine office visits in order to guarantee high external validity of such research. We report here the results of a consensus meeting of international movement disorder experts from the Genetic Epidemiology of Parkinson\'s Disease (GEO-PD) consortium, who convened to define which long-term outcomes are of interest to patients, caregivers and clinicians, and what is presently known about environmental or genetic factors influencing clinical progression or long-term outcomes in PD. We propose a panel of rating scales that collects a significant amount of phenotypic information, can be performed in the routine office visit and allows international standardization. Research into the progression and long-term outcomes of PD aims at providing individual prognostic information early, adapting treatment choices, and taking specific measures to provide care optimized to the individual patient\'s needs.
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  • 文章类型: Journal Article
    目的:推荐预防和处理以患者为中心的主要结局研究(PCOR)缺失数据的方法学标准。
    方法:我们在2012年1月搜索了美国国家医学图书馆的书架和目录以及监管机构和组织网站,以获取有关缺失数据的正式建议的指导文件。我们提取了包含的指导文件和建议的特征。使用两轮修改的Delphi调查,一个多学科小组提出了预防和处理PCOR缺失数据的强制性标准.
    结果:我们确定了1,790条记录,并评估了30条有相关建议。我们提出了10项强制性标准,涵盖三个领域。首先,唯一最好的方法是前瞻性地防止缺失数据的发生。第二,在分析缺失数据时,使用正确反映多种不确定性来源的有效统计方法至关重要。第三,对缺失数据的透明和彻底报告使读者能够判断调查结果的有效性。
    结论:我们敦促研究人员采用严格的方法,并通过将最佳实践应用于预防和处理缺失数据来促进良好的科学。为观察性研究和使用现有记录的研究制定预防和处理缺失数据的指导是未来研究的优先事项。
    OBJECTIVE: To recommend methodological standards in the prevention and handling of missing data for primary patient-centered outcomes research (PCOR).
    METHODS: We searched National Library of Medicine Bookshelf and Catalog as well as regulatory agencies\' and organizations\' Web sites in January 2012 for guidance documents that had formal recommendations regarding missing data. We extracted the characteristics of included guidance documents and recommendations. Using a two-round modified Delphi survey, a multidisciplinary panel proposed mandatory standards on the prevention and handling of missing data for PCOR.
    RESULTS: We identified 1,790 records and assessed 30 as having relevant recommendations. We proposed 10 standards as mandatory, covering three domains. First, the single best approach is to prospectively prevent missing data occurrence. Second, use of valid statistical methods that properly reflect multiple sources of uncertainty is critical when analyzing missing data. Third, transparent and thorough reporting of missing data allows readers to judge the validity of the findings.
    CONCLUSIONS: We urge researchers to adopt rigorous methodology and promote good science by applying best practices to the prevention and handling of missing data. Developing guidance on the prevention and handling of missing data for observational studies and studies that use existing records is a priority for future research.
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