CONCLUSION
This multi-method approach enriched our interpretation of literature and ‘real world’ data and facilitated identification and prioritization of important themes.
Seven of eleven recommendations were directly linked to the patient experience. Recommendations focused on multi-disciplinary, integrated follow-up of patients and best practice for incorporating patient wishes and life objectives.
Partnership with both patients and clinicians added a new and ener- gizing dynamic to our evaluation and recommendation processes.
Acknowledgements
We would like to thank all the patients and clinical experts for their participation in this project.
Disclosures
I have not had an affiliation (financial or otherwise) with a commercial orga- nization that may have a direct or indi- rect connection with the content of my presentation.
Contact information
laurie.lambert@inesss.qc.ca
BACKGROUND
The Cardiovascular Evaluation Unit of the Institut national d’excellence en santé et en services sociaux (INESSS) received a ministerial mandate to evaluate the pertinence of implantable cardiover- ter defibrillator (ICD) replacement. The decision-making process about repla- cement or revision of an ICD must be patient-centered as well as clinically appropriate. We engaged both clini- cians and patients in a multi-method approach to formulate recommenda- tions about structures and processes that facilitate shared and informed decision-making.
Co-constructing recommendations with patients and health professionals
Lambert L
1, Boothroyd L
1, Azzi L
1, Collette C
1, Brouillard P
1, Pomey M-P
2, Fournier M
1, Grégoire A
1, Ganache I
1, Brière A
1, Bogaty P
1,3, Racine N
4, de Guise M
11. Institut national d’excellence en santé et en services sociaux (INESSS), Montréal, 2. Université de Montréal, 3. Quebec Heart and Lung Institute, Québec, 4. Réseau québécois en cardiologie tertiaire and Montreal Heart Institute, Montréal.
KNOWLEDGE MOBILIZATION FOR HEALTH TECHNOLOGY ASSESSMENT ( HTA )
• MULTIDIMENSIONAL KNOWLEDGE APPROACH • ITERATIVE AND CONTINUOUS MODE OF KNOWLEDGE PRODUCTION
• DYNAMIC AND MULTIDIRECTIONAL EXCHANGE PROCESS
• BASED ON COLLABORATION AND INTERACTIONS WITH STAKEHOLDERS
STAKEHOLDERS* KNOW
LED GE**
KNOWLEDGE MOBILIZA
TION
DATA
SYNTHESIS DEVELOPMENT OF
RECOMMENDATIONS SCOPING AND
PLANNING KNOWLEDGE
TRANSFER AND MONITORING RECOMMENDATIONS
MONITORING OF IMPLEMENTATION
AND IMPACTS KNOWLEDGE TRANSFER AND IMPLEMENTATION
TOOLS
DECISION- MAKING
NEED
1 2 3 4
KNOWLEDGE APPROPRIATION AND TRANSFER
Update
SCIENTIFIC DATA CONTEXTUAL DATA EXPERIENTIAL DATA
PRACTIESCENG CHA
KNOWLEDGE MOBILIZATION FOR CLINICAL GUIDELINES DEVELOPMENT
• Multidimensional knowledge approach
• Based on collaboration and interactions with stakeholders
• Iterative and continuous mode of knowledge production
• Dynamic and multidirectional exchange process
METHODS
EXPERIENTIAL DATA
CONTEXTUAL DATA: PROVINCE-WIDE FIELD EVALUATION
We are here as expert- patients, and it was really helpful to hear and talk with others, because they lived a [similar]
experience.
– Patient As an epidemiologist,
I deal with numbers.
The patient’s committee brought home that each number is a human being.
– Researcher The implication of patients
as experts in this project has allowed INESSS to redefine the relevance of these treatments with the key persons concerned by them. The patients have permitted the integration of their unique experience of navigating the different steps in decision-making.
– Physician / director
Integrating the perspective of patients in the
development of a health technology evaluation report is one way to allow ethics to live in this report, by giving a voice to those the most directly affected by the device being analyzed.
– Ethicist
Chauveau
CISSS de la Montérégie-Centre CISSS de la Montérégie-Ouest
CISSS de la Montérégie-Est
14 Lanaudière 07 Outaouais
08 Abitibi-Témiscamingue
05 Estrie 04 Mauricie et
Centre-du-Québec
15 Laurentides
02 Saguenay-Lac-Saint-Jean
01 Bas-St-Laurent
11 Gaspésie-Îles- de-la-Madeleine 09 Côte-Nord
12 Chaudière-Appalaches 03 Capitale
nationale
16 Montérégie 10 Nord-du-Québec
13 Laval 06 Montréal
Îles de la Madeleine Île d’Anticosti
SCALE
300km 100 200
0
0 5 10
km
13 Laval
06 Montréal
Centre Mauricie
Legend
Amos
Granit
Magog Coaticook
Asbestos
St-Georges Ste-Croix
Pierre- Le Gardeur St-Eustache St-Jérôme
Du Suroît
Charles Lemoyne
Haut-Richelieu Honoré- Mercier Pierre- Boucher
Granby Brome- Missisquoi- Perkins
CHUS Arthabaska
IUCPQ (Hôpital Laval)
Thetford Mines Lévis Enfant-Jésus St-François
d’Assise
CHUL St-Sacrement
Hôtel-Dieu
Trois-Rivières
Rivière-du-Loup Rimouski Chicoutimi
Baie-Comeau
Chandler Sept-Îles
Cité de la Santé
Lakeshore
St.-Mary
Verdun Maisonneuve- Rosemont Institut de cardiologie
Sacré-Coeur
CHUM Jean-Talon
Hôpital Juif Rouyn-Noranda
Laurentien
Lanaudière
Heart failure clinic ICD satellite clinic
Other with monitoring of ICD patients
Hull Buckingham
Hôpital général
Cardiac surgery with ICD implant program
Cardiac surgery without ICD implant program
ICD implant program without cardiac surgery
Royal Victoria
Version anglaise
18 mai 2018 pour poster HTAISystematic review of the scientific literature concerning ICD replacement (2010-2017):
f Two rounds of consultation by email with sharing of de-identified comments amongst all members of the group
f One joint in-person meeting
DEVELOPMENT OF RECOMMENDATIONS SCIENTIFIC DATA
Clinical
guidelines Systematic reviews
Primary studies Registries
Qualitative studies of ICD patient experience
Recommendations INESSS evaluation team
Patients Clinical
experts
