Personne : Légaré, France
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Université Laval. Faculté de médecine
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- PublicationAccès libreEvidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study(Biomed Central, 2014-10-01) Giguere, Anik M. C.; Cauchon, Michel; Labrecque, Michel; Hayne, R Brian; Légaré, France; Grad, Roland; Pluye, Pierre; Greenway, Matthew; Carmichael, Pierre-HuguesBackground: Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. Methods: We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. Results: One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and access to printed Dboxes in consultation rooms. Conclusions: Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice
- PublicationAccès libreA Systematic Review of Instruments to Assess Organizational Readiness for Knowledge Translation in Health Care(2014-12-04) Gagnon, Marie-Pierre; Attieh, Randa; Ouimet, Mathieu; Ghandour, El Kebir; Légaré, France; Estabrooks, Carole A.; Grimshaw, JeremyBackground : The translation of research into practices has been incomplete. Organizational readiness for change (ORC) is a potential facilitator of effective knowledge translation (KT). However we know little about the best way to assess ORC. Therefore, we sought to systematically review ORC measurement instruments. Methods : We searched for published studies in bibliographic databases (Pubmed, Embase, CINAHL, PsychINFO, Web of Science, etc.) up to November 1st, 2012. We included publications that developed ORC measures and/or empirically assessed ORC using an instrument at the organizational level in the health care context. We excluded articles if they did not refer specifically to ORC, did not concern the health care domain or were limited to individual-level change readiness. We focused on identifying the psychometric properties of instruments that were developed to assess readiness in an organization prior to implementing KT interventions in health care. We used the Standards for Educational and Psychological Testing to assess the psychometric properties of identified ORC measurement instruments. Findings : We found 26 eligible instruments described in 39 publications. According to the Standards for Educational and Psychological Testing, 18 (69%) of a total of 26 measurement instruments presented both validity and reliability criteria. The Texas Christian University –ORC (TCU-ORC) scale reported the highest instrument validity with a score of 4 out of 4. Only one instrument, namely the Modified Texas Christian University – Director version (TCU-ORC-D), reported a reliability score of 2 out of 3. No information was provided regarding the reliability and validity of five (19%) instruments. Conclusion : Our findings indicate that there are few valid and reliable ORC measurement instruments that could be applied to KT in the health care sector. The TCU-ORC instrument presents the best evidence in terms of validity testing. Future studies using this instrument could provide more knowledge on its relevance to diverse clinical contexts.
- PublicationAccès libreAssessing patients' involvement in decision making during the nutritional consultation with a dietitian(John Wiley & Sons Ltd, 2014-07-17) Lapointe, Annie.; Vaillancourt, Hugues; Desroches, Sophie; Deschênes, Sarah-Maude; Légaré, FranceBackground Shared decision making (SDM) represents an interesting approach to optimize the impact of dietary treatment, but there is no evidence that SDM is commonly integrated into diet-related health care. Objective To assess the extent to which dietitians involve patients in decisions about dietary treatment. Methods We audiotaped dietitians conducting nutritional consultations with their patients, and we transcribed the tapes verbatim. Three trained raters independently evaluated the content of the nutritional consultations using a coding frame based on the 12 items of the French-language version of the OPTION scale, a validated and reliable third-observer instrument designed to assess patients’ involvement by examining specific health professionals’ behaviours. Coding was facilitated by the qualitative research software NVivo 8. We assessed internal consistency with Cronbach’s alpha and inter-rater reliability with the intraclass correlation coefficient (ICC). Results Of the 40 dietitians eligible to participate in the study, 19 took part. We recruited one patient per participating dietitian. The overall mean OPTION score was 29 ± 8% [range, 0% (no patient involvement in the decision] to 100% [high patient involvement)]. The mean duration of consultations was 50 ± 26 min. The OPTION score was positively correlated with the duration of the consultation (r = 0.65, P < 0.01). Internal consistency and inter-rater reliability were both good (Cronbach’s alpha = 0.72; ICC = 0.65). Conclusion This study is the first to use a framework based on the OPTION scale to report on dietitians’ involvement of patients in decisions about patients’ dietary treatment. The results suggest that involvement is suboptimal. Interventions to increase patients’ involvement in diet-related decision making are indicated.
- PublicationRestreintPostmenopausal women with abdominal obesity choosing a nutritional approach for weight loss: A decisional needs assessment(Elsevier, 2016-08-19) Lapointe, Annie.; Poirier, Nadine; Stacey, Dawn; Lemieux, Simone; Desroches, Sophie; Bégin, Catherine; Légaré, FranceObjectives: To identify the decisional needs of postmenopausal women with abdominal obesity choosing between two nutritional approaches for weight loss: a low-fat diet or a diet rich in fruit and vegetables. Study design: Our descriptive qualitative study was based on the Ottawa Decision Support Framework. Main outcome measures: Four focus groups were conducted with postmenopausal women. A thematic content analysis was performed to determine the decisional needs influencing the choice of a low-fat diet or a diet rich in fruit and vegetables. Results: Seventeen postmenopausal women participated in the study (median age 59 years). Most frequently reported decisional needs for each nutritional approach were sufficient levels of nutritional skills and knowledge, consideration of the physiological impacts and the sensory aspect of approaches, food availability, social support, finances and motivation. Partners, friends and daughters were considered as the most important individuals involved in the decision. Conclusions: We identified several decisional needs influencing postmenopausal women when choosing between a low-fat diet and a diet rich in fruit and vegetables. These findings could inform the design of decision support interventions that address the decisional needs of women for making and implementing informed decisions about a nutritional approach for weight loss.
- PublicationAccès librePsychosocial factors of dietitians’ intentions to adopt shared decision making behaviours : a cross-sectional survey(Public Library of Science, 2013-05-20) Deschênes, Sarah Maude; Lapointe, Annie.; Turcotte, Stéphane; Gagnon, Marie-Pierre; Desroches, Sophie; Légaré, FranceObjectives While shared decision making (SDM) promotes health-related decisions that are informed, value-based and adhered to, few studies report on theory-based approaches to SDM adoption by healthcare professionals. We aimed to identify the factors influencing dietitians' intentions to adopt two SDM behaviours: 1) present dietary treatment options to patients and 2) help patients clarify their values and preferences. Methods We conducted a cross-sectional postal survey based on the Theory of Planned Behaviour among 428 randomly selected dietitians working in clinical practice across the Province of Quebec, Canada. We performed descriptive analyses and multiple regression analyses to determine the variables that explained the variance in intention to perform the behaviours. Results A total of 203 dietitians completed the questionnaire. Their ages were from 23 to 66 and they had been practising dietetics for 15.4±11.1 years (mean ± SD). On a scale from 1 to 7 (from strongly disagree to strongly agree), dietitians' intentions to present dietary treatment options and to clarify their patients' values and preferences were 5.00±1.14 and 5.68±0.74, respectively. Perceived behavioural control (ß¿=¿0.56, ¿<0.0001), subjective norm (ß¿=¿0.16, ¿<0.05), and moral norm (ß¿=¿0.22, ¿<0.0001), were the factors significantly predicting the intention to present dietary treatment options, while perceived behavioural control (ß¿=¿0.60, ¿<0.0001), attitude (ß¿=¿0.20, ¿<0.05), and professional norm (ß¿=¿0.22, ¿<0.001), significantly predicted the intention to help patients' clarify their values and preferences.
- PublicationAccès libreExploration of shared decision‐making processes among dieticians and patients during a consultation for the nutritional treatment of dyslipidaemia(Blackwell Science, 2014-08-18) Lapointe, Annie.; Vaillancourt, Hugues; Gagnon, Marie-Pierre; Desroches, Sophie; Deschênes, Sarah-Maude; Légaré, FranceBackground: Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. Objective: Using a cross-sectional study design, we aimed to explore both dieticians’ and patients’ adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. Methods: Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: ‘to discuss nutritional treatment options for dyslipidaemia’ and ‘to discuss patients’ values and preferences about nutritional treatment options for dyslipidaemia’. These questionnaires were administered to the dietician–patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman’s partial correlations. Results: Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians’ and patients’ intentions to adopt the targeted SDM behaviours (P < 0.05). Conclusions: As perceived behavioural control seems to determine dieticians’ and patients’ adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice.
- PublicationAccès libreEconomic evaluations of scaling up strategies of evidence-based health interventions : a systematic review protocol(BMJ, 2021-09-30) Massougbodji, José; Gogovor, Amédé; Tchoubi, Sébastien; Rhéault, Nathalie; Zomahoun, Hervé Tchala Vignon; Brundisini, Francesca; Laberge, Maude; Uwizeye, Claude Bernard; Assan, Odilon; Légaré, FranceIntroduction: Scaling science aims to help roll out evidence-based research results on a wide scale to benefit more individuals. Yet, little is known on how to evaluate economic aspects of scaling up strategies of evidence-based health interventions. Methods and analysis: Using the Joanna Briggs Institute guidance on systematic reviews, we will conduct a systematic review of characteristics and methods applied in economic evaluations in scaling up strategies. To be eligible for inclusion, studies must include a scaling up strategy of an evidence-based health intervention delivered and received by any individual or organisation in any country and setting. They must report costs and cost-effectiveness outcomes. We will consider full or partial economic evaluations, modelling and methodological studies. We searched peer-reviewed publications in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception onwards. We will search grey literature from international organisations, bilateral agencies, non-governmental organisations, consultancy firms websites and region-specific databases. Two independent reviewers will screen the records against the eligibility criteria and extract data using a pretested extraction form. We will extract data on study characteristics, scaling up strategies, economic evaluation methods and their components. We will appraise the methodological quality of included studies using the BMJ Checklist. We will narratively summarise the studies' descriptive characteristics, methodological strengths/weaknesses and the main drivers of cost-effectiveness outcomes. This study will help identify what are the trade-offs of scaling up evidence-based interventions to allocate resources efficiently.
- PublicationAccès libreAssessments of the extent to which health-care providers involve patients in decision making : a systematic review of studies using the OPTION instrument(John Wiley & Sons Ltd, 2015-07-22) Turcotte, Stéphane; Robitaille, Hubert; Vaillancourt, Hugues; LeBlanc, Annie; Couët, Nicolas; Desroches, Sophie; Elwyn, Glyn; Légaré, FranceBackground: We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. Objective: To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. Search strategy: We conducted online literature searches in multiple databases (2001–12) and gathered further data through networking. Inclusion criteria: (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. Data extraction: Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. Main results: We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0–100 scale). When assessed, the variables most consistently associatedwith higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). Conclusions: Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this.
- PublicationAccès libreApproaches to considering sex and gender in continuous professional development for health and social care professionals : an emerging paradigm(Taylor & Francis, 2018-07-28) Bilodeau, André.; Borduas, Francine; Dogba, Maman Joyce; Monette, Céline; Blair, Louisa; Robitaille, Hubert; Rhugenda, Sylvie-Marianne; Stacey, Dawn; Gagnon, Marie-Pierre; Tanguay, Dominique; Bélanger, Annie-Pierre; Tremblay, Marie-Claude; Bussières, André; Desroches, Sophie; Gosselin, Hélène.; Roch, Geneviève; Jose, Caroline; Légaré, FranceConsideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.
- PublicationAccès libreCase management in primary care among frequent users of healthcare services with chronic conditions : protocol of a realist synthesis(BMJ Publishing Group Ltd, 2017-09-03) Hudon, Catherine; Godbout, Julie; Groulx, Antoine; Aubrey-Bassler, Kris; Chouinard, Maud-Christine; Muhajarine, Nazeem; Gauthier, Gilles; Burge, Fred; Guénette, Line; Pluye, Pierre; Légaré, France; Bush, Paula Louise; Ramsden, Vivian Rose; Morin, Paul; Lambert, Mireille; Couture, Martine; Campbell, Cameron; Baker, Margaret; Edwards, Lynn; Sabourin, Véronique; Spence, Claude; Warren, Mike; Davis, Breanna; Rabbitskin, NormaIntroduction: A common reason for frequent use of healthcare services is the complex healthcare needs of individuals suffering from multiple chronic conditions, especially in combination with mental health comorbidities and/or social vulnerability. Frequent users (FUs) of healthcare services are more at risk for disability, loss of quality of life and mortality. Case management (CM) is a promising intervention to improve care integration for FU and to reduce healthcare costs. This review aims to develop a middle-range theory explaining how CM in primary care improves outcomes among FU with chronic conditions, for what types of FU and in what circumstances. Methods and analysis: A realist synthesis (RS) will be conducted between March 2017 and March 2018 to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to RS methodology, five steps will be followed: (1) focusing the scope of the RS; (2) searching for the evidence; (3) appraising the quality of evidence; (4) extracting the data; and (5) synthesising the evidence. Patterns in context–mechanism–outcomes (CMOs) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, modify or add to the components of our initial rough theory and ultimately produce a refined theory explaining how and why CM interventions in primary care works, in which contexts and for which FU with chronic conditions. Ethics and dissemination: Research ethics is not required for this review, but publication guidelines on RS will be followed. Based on the review findings, we will develop and disseminate messages tailored to various relevant stakeholder groups. These messages will allow the development of material that provides guidance on the design and the implementation of CM in health organisations.