背景:女性受到骨关节炎(OA)的影响不成比例,但与男性相比,女性获得早期诊断和治疗的可能性较小,或体验通过以人为本的方法定制的OA护理,以满足他们的需求和偏好,特别是种族歧视的女性。支持临床医生优化OA护理的一种方法是通过临床指南。我们旨在审查OA指南的内容,以指导提供公平,对包括妇女在内的弱势群体提供以人为本的护理。
方法:我们在索引数据库和网站上搜索了2000年或以后由非营利组织发布的英语OA相关指南。我们使用清单内容分析来提取数据,以及汇总统计数据和文本来描述指南特征,使用六域PCC框架的以人为中心的护理(PCC),OA患病率或交叉因素的障碍,以及改善获得OA护理的公平机会的策略。
结果:我们纳入了2003年至2021年在8个地区或国家发布的36项OA指南。很少(39%)发展小组包括患者。虽然大多数(81%)指南至少包括一个PCC域,指导通常是简短或模糊的,很少有地址交换信息,对情绪做出反应并管理不确定性,没有人提到培养一种治愈的关系。少数(39%)的指南承认或描述了特定群体中OA的患病率较高;只有3%(8%)指出,社会经济地位是OA护理的障碍,只有2名(6%)向临床医生提供了如何改善OA护理公平获得的指导:评估可接受性,可用性,可访问性,和自我管理干预措施的可负担性;并采用风险评估工具来识别手术后无法在家中应对的患者。
结论:这项研究表明,OA指南不支持临床医生照顾因影响获得和护理质量的交叉因素而面临劣势的不同OA患者。开发人员可以通过纳入可从现有框架和工具中提取的PCC和公平性指南来加强OA指南,并将不同的OA人员纳入指南制定小组。需要未来的研究来识别多层次(患者,临床医生,系统)可以通过指导方针或其他方式实施的战略,以提高公平性,以人为本的OA护理。
■这项研究是由一组研究人员通知的,合作者,和十三个有生活经验的不同女性,为规划做出了贡献,和数据收集,通过审查学习材料并提供口头(在会议期间)和书面(通过电子邮件)反馈进行分析和解释。
BACKGROUND: Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical
guidelines. We aimed to examine the content of OA
guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women.
METHODS: We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe
guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care.
RESULTS: We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%)
guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery.
CONCLUSIONS: This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on
guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care.
UNASSIGNED: This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.