dissemination strategies in healthcare

The limits of patient power. Allu et al. Does tailoring matter? Implementation and dissemination are those methods utilised to encourage uptake of evidence by prac- The use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. Therefore, we will integrate the information qualitatively into understandable text and summary tables. 2013. Rockville, MD; 2005. The information should be made relevant for the target audience, patients in this case. Qual Saf Health Care. SPINE. PMID: 11281931. The level of evidence was categorised according to the design characteristics of available studies using an established hierarchy [20] (see Table 1). It should be planned in consultation with the project partners and approved by the project management committee. Knowledge transfer and exchange: review and synthesis of the literature. We do, however, know that event-based knowledge mobilisation may be effective for the initial dissemination of guidelines. by Rani Elwy, PhD, MSc Seminar date: 10/15/2018 Seminar time: 1:00pm-2:00pm » REGISTER to attend this session Description: Many effective programs emerging from research fail to have a significant impact on population health because no plans are made to disseminate these … A dissemination plan is needed to clarify at the start of the project the target audience, which will subsequently determine the scope, objectives, format, style and wording of the recommendations as well as the tools for dissemination [22]. We will define research-based evidence as evidence that has been assembled, reviewed, and presented by evidence developers and has been used to make recommendations. Google ScholarÂ. 2005;66:124–97. CJEM. PMID: 17873256. 3.Program Development – methods. Visschers VH, Meertens RM, Passchier WW, et al. We will also exclude decision aids given the volume of other research (e.g., Cochrane collaboration) focusing on them. We also thank Quince Blits, junior researcher, who was temporarily involved in the project. Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audience. PMID: 18087058. In fact, the most successful dissemination processes are typically designed prior to the start of Moxey A, O'Connell D, McGettigan P, et al. This review will hopefully enable other national organisations of patients and health professionals to develop their own strategy to disseminate national or international recommendations to patients. ORIGINALITY/VALUE: There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. Patient and public involvement in clinical practice guidelines: a knowledge synthesis of existing programs. PMID: 18480036. The translations are then compared, and an agreed version is drawn up between the translators and those involved in the development of the original version. After deleting duplicates, all articles (title and abstract) were screened for inclusion, independently by two reviewers (KS and MB). We will also exclude studies that compare alternate presentations of point estimates, as these studies have been well summarized in previous reviews on risk communication.26,35-37. In this discussion, we evaluate this assumption in the light of our results and existing literature. It should be planned in consultation with the project partners and approved by the project management committee. Agency for Healthcare Research and Quality. The Canadian National EMS Research Agenda: impact and feasibility of implementation of previously generated recommendations. The EPC solicits input from Key Informants when developing questions for systematic review or when identifying high-priority research gaps and needed new research. [6] and Allu et al. Information delivery via phone, Webinar, or in-person visits, including purposeful delivery of brochures/pamphlets; can include pharmacists, nurses, doctors, counselors, but does not include a motivational component. Training and support for patients are described as helpful and are therefore needed to make the involvement of patients in the development and dissemination of recommendations successful [2, 22, 38] which in the end will lead to more successful dissemination of the guidelines to patients and patient organisations. Dissemination of data is a critical step in completion of any research study. A well-known pitfall is that information is often too difficult for the general public [24, 25] and in particular for less literate persons [25]. The Agency for Healthcare Research and Quality (AHRQ) Effective Healthcare (EHC) Program funds individual researchers, research centers, and academic organizations to work with AHRQ to produce effectiveness and comparative effectiveness research for clinicians and consumers.1 Comparative effectiveness research (CER) compares the benefits, harms, and effectiveness of health interventions for the prevention, diagnosis, treatment, and management of clinical conditio… A review protocol was developed by KS and JK, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement [15]. For purposes of our review, communication techniques fall into the broad area of “health communication” and focus on making evidence interpretable, persuasive, and actionable. Available at. Implement Sci. Active dissemination strategies involve active efforts to spread evidence-based information via specific strategies and channels. Tailored communication delivered via print or the Internet is more effective than nontailored communication in increasing knowledge and changing behavior. To be included in our final article, the article had to refer to (1) guideline(s) or recommendation(s), (2) dissemination, (3) dissemination with patients/patient organisations and (4) dissemination for patients/patient organisations. This can be done by using their own website, newsletters, brochures, other publications, phone calls, support groups, workshops, events, seminars, annual conferences, local or regional events, events for professionals and/or patients, press releases, print-ready ads, fillers or by including the recommendations in their information packages provided to their members [38]. This empowers them to become effective partners in the dissemination and implementation process [38]. We expect that most studies will focus on intermediate outcomes because they occur sooner and, thus, are more practical to study. The disposition of all items, (starting with the initial yields of the searches) through to articles finally retained for synthesis, will be reported in a flow diagram conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Such conditions may be associated with heterogeneity of treatment effect and the ability to generalize the effectiveness of an intervention to use in everyday practice. The main objective of dissemination is to increase and promote the spread of knowledge regarding evidence based interventions, with an intention of enhancing its greater application and patient outcomes (Cain & Mittman, 2012). Milbank Q 2004;82(4):581-629. Biases may result from study design, study conduct, or confounding by other external variables. Evidence reports are typically targeted at scientific researchers in related fields, rather than the patients or clinicians who ultimately make health care decisions. 2.Delivery of Health Care – methods. To date, most work on presenting uncertainty has focused on stochastic uncertainty: the chance or probability of an event occurring. Higgins JPT, Altman DG. In addition, we will exclude studies that address uncertainty arising from any of the following circumstances: multiple causes of illness, changes in risks over time, lack of knowledge about evidence that is available, unclear patient values, trade-offs between benefits and harms in limited-resource settings, concerns about clinicians’ competence, concerns about how a medical illness will affect family and friends, imperfect diagnostic testing, or uncertain prognosis. 2011;64(4):380–2. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this … Abstracts that met the inclusion criteria were selected for detailed, full text review. Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audience. This process is called dissemination. We will also assess potential biases in reporting. Results of a multinational survey among nurses rheumatologists and patients. First, it addresses the comparative effectiveness of communicating the evidence in various contents and formats that increases the likelihood that it will be understood and used by the target audience. The articles are mainly about the field of rheumatology, asthma/COPD and diabetes. Ideally, a heterogeneous group of patients with different educational levels [38] should be involved in order to communicate to a diversity of patients [22, 23, 37]. Vol 4. • Supports dissemination of evidence-based strategies to improve health • Research conducted at UW-Madison or Marshfield • Supports activities such as: • Targeted distribution of research findings , products or materials to a specific audience • Development of materials in preparation for dissemination and/or implementation activities Description: Many effective programs emerging from research fail to have a significant impact on population health because no plans are made to disseminate these programs to agencies and organizations that can use them. The John M. Eisenberg Center for Clinical Decisions and Communications Science translates AHRQ’s comparative effectiveness review information to create a variety of materials ranging from evidence summaries to decision aids and other products. Abrahamian Y, Watson H. Strategies for health system implementation of guidelines on overweight and obesity. Politi et al.29 suggest using subjective descriptions, various depictions of numbers, or visual aids to represent uncertainty and its degree. Peer Reviewers do not participate in writing or editing of the final report or other products. The risk of bias is the degree to which individual studies are protected from systematic errors or bias. Transforming healthcare organizations into a setting where an EBP culture exists requires persistence, patience, and perseverance (Melnyk &Fineout-Overholt,2018). Patients are expected to be able to review scientific evidence objectively and to approach the recommendations from a wider patient perspective rather than individual preconceived views or self-interests [22]. Dissemination strategies aim to spread knowledge and the associated evidence-based interventions on a wide scale within or across geographic locations, practice settings, or social or other networks of end-users such as patients and health care providers. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. AHRQ is seeking nominations of promising patient-centered outcomes research (PCOR) findings with the potential to improve patient health outcomes for future dissemination and implementation activities.. PCOR compares the impact of two or more preventive, diagnostic, treatment, or health care delivery approaches on health outcomes, including those that are meaningful to patients. dissemination plan has been successful and to help form future plans 6. In health care, many guidelines or recommendations for the management of diseases are developed. For sustainable adaptation, more efforts are needed [29]. Dissemination strategies aim to spread knowledge and the associated evidence-based interventions on a wide scale within or across geographic locations, practice settings, or social or other networks of end- users such as patients and health care providers. Clinical or community settings in the United States, such as: Any other country not specified for inclusion, Sources: Owens et al. Dissemination of additional types of data, such as quality or benchmarking data, can be equally important in advancing the evidence base to support nursing interventions and optimize patient outcomes across settings. Nursing and Health Care Perspectives, 22(3), 124‐129. CAS  Strategies to disseminate evidence that will: Techniques to explain uncertain evidence using: Intermediate outcomes for all target audiences. 2008;17(4):296–300. Professionals reported the discrepancy between the perspectives of themselves and patients as an important barrier in the development of recommendations. ... Agency for Healthcare Research and Quality. Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. The search was performed in February 2016 in PubMed, Ebsco/PsycINFO, Ebsco/CINAHL and Embase. 1. Development of a Planning Tool to Guide Dissemination of Research Results. Article  Studies marked for possible inclusion by either reviewer will undergo a full-text review. Meta-analytic review of tailored print health behavior change interventions. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and provide valuable insights. Légaré F, Ratté S, Gravel K, Graham ID. Training for professionals should however also get attention since professionals also have to learn how to work effectively together with patients [51]. PubMed Google Scholar Two trained members of the research team will independently review each full-text article for inclusion or exclusion on the basis of the eligibility criteria described earlier. PMID: 17873250. A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. Privacy The GIN toolkit suggests that patients who have participated in the development of the recommendations can also actively contribute to the dissemination process [38]. PubMed, Ebsco/PsycInfo, Embase.com and Ebsco/Cinahl were searched on 4 February 2016, all from inception, by KS and JK. The use of internet and digital tools like websites and apps seems to be promising and necessary to reach patients [30, 31]. Outcomes: use of composite outcomes that mix outcomes of different significance to patients, Settings: restrictions to certain types of health care institutions when services might be rendered in many different locales or venues, and. Knowledge brokers can also be used. Criteria 1 AND 2 were mandatory together with criteria 3 OR 4. National patient organisations should, according to the GIN toolkit, disseminate the recommendations in their own countries. We will account for studies reported in multiple articles. Given AHRQ’s mission, a critical goal is to evaluate the effectiveness of strategies to make evidence report findings widely available and techniques to ensure that such findings are correctly understood. Edwards A, Elwyn G, Covey J, et al. Guidelines should be easily searchable and accessible immediately [30, 31]. NIH Conference. assertiveness) [38]. 1998–2007, Latimer et al., 201014 They have experienced that the involvement of patients with different native tongues enhances the likelihood that the lay version can be easily understood by many patients and that an English lay version can easily be translated into various languages because typical English phrasings are avoided. For communication and dissemination (KQs 1 and 2), we will only include health-related evidence that seeks to promote informed decisions about individual-level human health, reflecting our general interest in prevention, diagnosis, and treatment. We will include comparisons of two or more of the included dissemination strategies head to head or, in other words, comparisons between rows. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? Despite the numerous advances made in clinical and public health research over the past few decades, discontinuity still exists in the process of disseminating and implementing research discoveries into practice settings [1–3].The dissemination and implementation of these discoveries are important in working towards improving the population’s health [4, 5]. These include (1) patients and the general public and (2) clinical service providers, including physicians, nurses, mid-level providers, and/or pharmacists who deliver health care. The relationships can be informal (friends, peers, or family) or formal (patient/provider/nurses) that have defined role obligations. Strategies for disseminating recommendations or guidelines to patients: a systematic review. Why don't physicians follow clinical practice guidelines? This review also identified a significant knowledge gap regarding effective dissemination strategies: More valid and credible research has to be conducted in order to obtain higher levels of evidence for the effects, efficiency and barriers of existing dissemination strategies and the role of patient organisations in that process. We expect some overlap in results among the three searches (for the three KQs). Quality Assessment Tool for Qualitative Studies. Most of the 21 papers can be described as opinion papers or papers that describe strategies that have been used or might be effective. Therefore, recommendations about screening are derived indirectly from evidence that a preclinical disease can be detected and that there is benefit in treating that same disease once symptomatic. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and provide valuable insights. The following terms were used (including synonyms and closely related words) as index terms or free-text words: ‘guidelines’ or ‘recommendations’ and ‘dissemination’ and ‘patients’ or ‘consumers’. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. O'Keefe DJ, Jensen JD. First, the message should be customised to the target audience. J Vocat Behav. This might include tracking sheets to be given to patients and risk calculators to be used by clinicians. All authors read and approved the final manuscript. PMID: 14687282. One way to empower patients to make more informed choices is the development and dissemination of patient or lay versions of the recommendations. Ann Rheum Dis. Dissemination is seen as playing a key role in building sustainable health and social ecosystems while supporting society. End-users also need to grasp whether the evidence is applicable for their own unique populations and settings. (DOC 47 kb). In examining influences that help spread innovations along the continuum between passive diffusion of information and active dissemination, Greenhalgh et al.15 created an inventory of strategies aimed at influencing individual, social, and other networks of adopters. Although the findings of our study regarding the value of a multifaceted and active strategies are much in line with studies on dissemination towards professionals [43, 44], the applied tools and methods are different. Diabetes.ca in action. 2010;16(6):501–10. (2011).34 Blocks 1 and 2 contain countries in the core of the world system. The effects of information framing on the practices of physicians. Two trained members of the research team will independently review all titles and abstracts identified through searches for eligibility against our inclusion/exclusion criteria. Dissemination is an essential component of the quality improvement cycle, ensuring the best available evidence is incorporated into … How patients and their organisations can be involved is described below. Provision of supporting “how-to” materials, including physical materials that might be used by a practice to put evidence into use. We will include studies that examine intermediate outcomes. A final concern may be the question whether recommendations are still valid when being translated or adapted. Dissemination is seen as playing a key role in building sustainable health and social ecosystems while supporting society. Assessing risk of bias in included studies. 2015;4:113. doi:10.1186/s13643-015-0100-9. Owens DK, Lohr KN, Atkins D, et al. Forty-seven articles met the inclusion criteria and were selected for detailed review. Article  The aim of this systematic literature review is to assess the feasibility of dissemination strategies to inform and educate patients about recommendations or guidelines. J Health Commun 2007 Oct-Nov;12(7):623-44. mention, based on their own experiences, the combination of the following strategies: organising press conferences, providing lay versions through Public Libraries, developing books to reach children and developing posters with ‘trigger’ stickers or making a website endorsed by a VIP [6]. Caron-Flinterman JF. It is argued that the process of dissemination needs to be afforded greater emphasis by project-funding bodies, research supervisors, researchers, and those responsible for implementing … Ten adult patients are given the translated version and are interviewed about the interpretation and wording of each item. The terminology for each of these steps overlaps considerably. 2013;6(3):260–5. 2006;14:548–57. Strategies where health professionals and patient organisations join forces will probably be even better. Grades reflect the strength of the body of evidence to answer the KQs on the comparative effectiveness of the interventions in this review. Alternate presentations of the specified interventions, Any length of followup will be permissible. Smith C. The role of health professionals in informing cancer patients: findings from The Teamwork Project (phase one). Med Decis Making 2011 Mar-Apr;31(2):354-66. Obtain feedback from end users. Eby LT, Casper WJ, Lockwood A, Bordeaux C, Brinley A. Monograph—work and family research in IO/OB: content analysis and review of the literature (1980–2002). Although Cochrane suggests to exclude descriptive papers, editorials or opinion papers, we have included those papers because of the lack of articles with a level of evidence of 1 (meta-analysis of randomised controlled trials) or 2 (single randomised controlled trials). N = 20,180 Roy C. (1999). By optimizing the presentation of uncertainty, evidence creators, synthesizers, and disseminators can enable people to make the best possible decisions. Can J Diabetes. Technical experts constitute a multidisciplinary group of clinical, content, and methodological experts who provide input regarding methodological issues and scoping the reviews. This systematic review has three related components; all focus on promoting informed health and health care decisions among patients and providers. These communication strategies are widely used and can be considered best practices; however, they are not included in this review given our focus on comparative effectiveness of different techniques. In the context of this review, the word guidelines and recommendations are used as synonyms. Characteristics can be determined by role, demographic, or social psychological variables. 2009;19(3):401–15. Statistical analysis, including adjustment for multiple comparisons, clustering, and use of intention-to-treat analysis, Results in intervention and control groups, Literacy/numeracy level of audience intervention intensity and/or complexity, Format of presentation (graphical, numeric, non-numeric, combination). The US Agency for Health Research and Quality supported development of a very brief planning tool that walks though dissemination step by step visual guidance for thinking though dissemination, brainstorming audiences and thinking through the tools needed to reach those audiences. They can provide information on their websites, can coordinate web-communities, can organise self-management trainings and other educational events and publish patient magazines, books and brochures. The intent is to spread knowledge and the associated evidence-based interventions. J Public Health Manag Pract. PMID: 11317424. The strength of the evidence represents the degree of confidence that the estimates of effects underlying evidence are correct and is used to provide a comprehensive evaluation of the evidence and an assessment of whether additional evidence might change conclusions. KS made the review protocol, conducted the literature search, formulated the inclusion criteria, selected the papers, assessed the level of evidence of the papers, conducted the content analysis/data synthesis and made the first draft of this paper. Chest. 20 Dissemination of Findings: How to Share Results Once the evaluation is completed, it is important to share the results and/or evaluation procedures with a variety of stakeholders. To choose the right dissemination strategies means thus to combine passive and active strategies. J Psychosoc Oncol 2002;20:69-84. 2012;7:67. doi:10.1186/1748-5908-7-67. The findings were helpful to develop a practical guide for national patient organisations to promote the dissemination of recommendations among patients. Similar to the condition of patient involvement in the development of recommendations, patients and patient organisations should be actively encouraged to support and contribute to the actual dissemination. A criterion may be the ability to consider the evidence objectively and to make recommendations that do not depart from preconceived views or self-interests [22]. The decision will be based on the total number of studies and, assuming a sufficient number of studies are potential candidates for such analyses, on an assessment of both the clinical and the statistical heterogeneity of the data. Possible moderators of interest for all key questions include: risk of bias, study size, and target audience. We will conduct an updated literature search (of the same databases searched initially) concurrent with the peer review process. … Dissemination workplan‐provides a framework for organizing your strategy. Nominations. A test of numeric formats for communicating risk probabilities. 2012;7:70. doi:10.1186/1748-5908-7-70. Roy C. (1999). Our study is the first systematic literature review that provides an overview of strategies to disseminate recommendations to patients or patient organisations and how to involve patients in this process. Many hope that better communication and dissemination of CER will result in more widespread use of such information. Within the EPC program, the Key Informant role is to provide input into identifying the KQs for research that will inform health care decisions. 2012;7:60. van Tulder MW, Croft P, van Splunteren P, Miedema HS, Underwood MR, Hendriks HJM, et al. Can Respir J. To recap, our review has three Key Questions (KQs), listed below. The TOO reviewed contract deliverables for adherence to contract requirements and quality. Uncertainty creates multiple challenges, including difficulties: (1) determining whether preventive services and treatments should be implemented in clinical practice, (2) determining for whom and in what settings preventive services and treatments should be implemented, and (3) communicating evidence so that consumers can make informed decisions. The targeted distribution of information and intervention materials to a specific public health or clinical practice audience. Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. Appiah B, Hong Y, Ory MG, Helduser JW, Begaye D, Bollin JN, et al. Greenhalgh, focusing on system-level practices in large health care organizations, reviewed the literature on dissemination and diffusion and developed a conceptual framework to organize it. 2009;68(9):1381–6. 2012 Feb;65(2):163-78. Probability information in risk communication: a review of the research literature. recommend to take the following aspects into account when developing a lay version. Second, involve patients in less traditional ways (e.g. Med Decis Making 2007 Sep-Oct;27(5):638-54. Dissemination workplan‐provides a framework for organizing your strategy. Techniques of interest include tailored communication, communication targeted at audience segments; use of narratives; and message framing (see Table 5). Kuhn KM, Budescu DV. An ethnodrama. The authors are from the Canada (7), Europe (7), USA (5), Russia (1) and Africa (1). Other authors [39] suggest to use a participatory (action) research (PAR) in order to involve patients in the development of guidelines/lay versions. Various ways of communicating uncertainty-associated health-related evidence to different target audiences (KQ 3). Institute of Medicine. These strategies are designed to make information clearer, easier to understand, and more relevant to end-users. PMID: 17592961. Patients who have access to lay versions are better equipped to prepare themselves for the consultation with their health care provider and are expected to become an active partner in their own treatment [6]. Dissemination is the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings. Ann N Y Acad Sci 1993 Dec 31;703:226-35; discussion 35-7. Coupled with these mandates is the fact that the ad hoc Uncertainty Committee of the EHC Stakeholder Group is interested in promoting effective ways to communicate uncertainty about health and health care evidence to end-users. We will also exclude studies that compare permutations of the included communication techniques, which is comparison within the rows above as opposed to across the rows above, for the same reason. Epub 2015 Feb 12. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program. Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. Sometimes there are problem or group-specific social networks for professional organizations and patient subgroups; these would also fall into social media as long as they have a “social” network component as described above. A limitation might be the low level of evidence of most included articles. Champions help overcome social and political pressures imposed by an organization, role model personal commitment to the program, and involve others in its use. Rockville, MD: Agency for Healthcare Research and Quality; April 2011. Patient and public involvement in guidelines. Develop an evaluation plan for the dissemination strategy. Gen Intern Med. All languages were accepted. The Quality Assessment Tool for Quantitative Studies was used for assessing the quality of the quantitative studies [17] (see Additional file 2). Dissemination of research findings or other key messages is increasingly acknowledged as a vital yet complex process. Health Expect 2013; 2013/02/01 doi: 10.1111/hex.12048. Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Personal stories of patients in media can also help to raise awareness of new recommendations [38]. J Clin Epidemiol. We will assess the applicability both of individual studies and of the body of evidence for specific KQs.38 For individual studies, we will examine characteristics that may limit applicability based on the PICOTS structure. Both reviewers (KS and MB) conducted the analysis separately and then explored similarities and differences between the studies. Changing provider behavior: an overview of systematic reviews of interventions. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13012-016-0447-x. 290-2007-10056-I #7 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. This review is part of the European League Against Rheumatism (EULAR) project to develop a practical guide for patient organisations to improve the dissemination of EULAR recommendations to people with rheumatic and musculoskeletal diseases. We focus this review on uncertainty in a body of evidence and how to effectively communicate this uncertainty to target audiences in ways that allow informed decisions. Furthermore, the information in the recommendations should be consistent, unambiguous and credible [6]. Dannapfel P, Poksinska B, Thomas K. PURPOSE: The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare … Searches were not restricted by language or publication type. Those champions assist in the dissemination of information to patients [6]. What does it mean to be a patient research partner? Greenhalgh T, Robert G, Macfarlane F, et al. Involve dissemination partners in evaluating dissemination activities. The involvement of patients, if done properly, increases the comprehensiveness of the recommendations because patients use other words and less jargon compared to professionals and their involvement makes the adaption of the recommendations to the target population easier because of their ‘patient knowledge’ [22, 23, 37]. As taken from Owens et al.,27 these domains are as follows: Each domain may individually contribute to the uncertainty about the evidence. 1.Research. We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results. For instance, evidence on the benefits of screening is often not directly available (i.e., there are no studies that enroll subjects and assign them to appropriate treatment or not). 2012;21:612–5. dissemination strategy in healthcare. Publications that referred to (1) guideline(s) or recommendation(s), (2) dissemination, (3) dissemination with patients/patient organisations and (4) dissemination to patients/patient organisations were included in this article. Grading the strength of a body of evidence when comparing medical interventions. Disagreements between the two reviewers will be resolved by discussion and consensus or by consulting a third, senior member of the team. Risk Analysis1987 Dec;7(4):519-29. Team approaches were found across varied populations. Dissemination and evaluation of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Examining the effectiveness of a knowledge mobilization initiative for disseminating the physical activity guidelines for people with spinal cord injury. Admissible settings include inpatient and outpatient settings and clinics of all types; academic health care institutions; and community-based settings such as churches, fraternal organizations, professional or social clubs, pharmacies, and homes. The reference lists of articles from the search that fit the criteria were scanned for missing papers. Techniques and strategies that work well for one audience may not work as well for another audience. However, a study of Snyman suggests that just making a lay version is not enough to achieve this goal because most printed health messages do not transfer information successfully to target audiences [25]. In this Cyberseminar, we will discuss the science of dissemination, describe evidence-based dissemination strategies, cover important dissemination lessons … We will hand search bibliographies of included articles. Eccles MP, Grimshaw JM, Shekelle P, Schünemann HJ, Woolf S. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Implementation of the osteoarthritis clinical guideline: results of a cluster randomized trial in primary care. ISBN 978 92 4 150696 0 (NLM classification: W 20.5) Peer Reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. We will not examine interventions designed to help individuals cope with uncertainty. The group followed the EULAR Standardized Operational Procedures [14] and met twice. The steps that we will take to accomplish the literature review are described below. Plan for dissemination. Dissemination strategy Steps in developing a dissemination strategy Barriers Conclusion . Adaptation of the recommendations to the local situation may be needed [34]. For example, an opinion leader might be the chief executive officer of a company or the head of a department, or an external expert in a particular field applicable to the evidence, or a well-recognized figure like the Surgeon General of the United States. Boulet LP, Becker A, Bowie D, Hernandez P, McIvor A, Rouleau M, et al. Health Expect. Elberse J, Caron-Flinterman JF, Broerse JEW. J Clin Epidemiol. A hand search and a search in the grey literature, also done in February 2016, were added. Part of Dissemination and implementation strategies for healthcare teams and team‐based practice were identified in 88 studies from 1995 to 2007. Health Bucks Evaluation Toolkit pg. Patients involved in the dissemination process have specific needs that should be taken into account. We will retrieve and review the full text of all articles included during the title/abstract review phase. Patient organisations can furthermore organise an annual national forum on a disease at which people share their experiences and take part in training and education programmes. This tool leads to an overall methodological rating (strong, moderate or weak) taking important elements into account such as selection bias, study design, confounders, blinding, data collection methods, withdrawals/dropouts, intervention integrity and analysis [17]. Uncertainty (KQ 3): Health and health care evidence inherently involves some degree of uncertainty. Another option is, according to Boulet et al., the development of community ‘champions’: through train-the-trainer sessions, community leaders are trained to become ‘champions’. High-quality studies must be conducted and the body of evidence must then be synthesized and summarized, often in the form of systematic reviews. They may include awareness about the evidence; knowledge about the evidence; discussions about the evidence; behavioral intentions to use or apply the evidence; and self-efficacy. We will exclude studies that examine interpersonal communication techniques given that these are more costly to implement and less practical when reaching large-scale audiences. Milbank Q 2007 Dec;85(4):729-68. We will remove duplications in our EndNote database and track the yield from each search. Only one study was assessed as having a level of evidence of 2B (controlled study). In some cases, patient friendly decision aids may also be an adequate tool for dissemination of recommendations to patients although more research is needed to define condition where decision aids can replace or complement lay versions of recommendations. We will exclude Federal and State policymakers because they have less direct impact on clinical decisionmaking when compared with patients and providers. As noted in the box to the far left, we plan to examine studies that use research-based evidence as the source of information for their communication techniques (KQ 1) and dissemination strategies (KQ 2). Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. (2010)41 and AHRQ (2011). N = 6,679 Med Care. PubMed  This article gives an overview of tools and strategies to disseminate recommendations to patients. This may be a result of the problems professionals expressed on patient involvement in the development of recommendations [2]. For example, a study that compares targeting information to different types of audience segments (e.g., by race or ethnicity, sex or gender, and/or age groups) will be excluded. Discussion Questions. II.UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. In: Scott J and Carrington P, eds. For studies that meet inclusion criteria, we will abstract relevant information into evidence tables. Opinion/thought leaders (frequently has an endorsing or persuasive element), such as a recognized expert in his or her field who lends his or her name to dissemination efforts to establish credibility. We will sort the studies into prevention and diagnosis/treatment categories after the abstract and/or full-text review process and confer with AHRQ about the possibility of including both the prevention and diagnosis/treatment categories based on the number of studies in each category and available resources. The full search strategies for all databases can be found in Additional file 1. J Clin Epidemiol 2010 May;63(5):513-23. High confidence that the evidence reflects the true effect. Swedish healthcare is publicly funded and residents are insured by the state, with equal access for the population and fees regulated by law. Patients have therefore limited access to information to get an adequate understanding of their disease and treatment options. Lomas J. Diffusion, dissemination, and implementation: who should do what? Overall there may be net benefit, clinical equipoise (benefit that is too close to call at the population level), or net harm. 2010. doi:10.1111/j.1369-7625.2010.00647.x. The 21 papers were assessed for the level of evidence and were scored level 3 (descriptive studies, such as comparative studies, correlation studies or case-control studies) or 4 (expert committee reports or opinions; Table 2). Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, Medical Library, VU University, Amsterdam, The Netherlands, Department of Medical Humanities/EMGO+, VU University Medical Center, Post box 7057, 1081 BT, Amsterdam, The Netherlands, You can also search for this author in Module 7: Dissemination of Rural Telehealth Programs When implementing or expanding a telehealth program, it is important to share information and results with others. The first factor concerns the development of a dissemination plan [21, 22]. doi:10.1136/ard.2004.023697. Dissemination of research findings or other key messages is increasingly acknowledged as a vital yet complex process. Soc Sci Med 2008 Dec;67(12):2079-88. Based on a survey among professionals, McGuire et al. If studies are similar and we proceed with quantitative analyses, we will assess statistical heterogeneity by calculating the chi-squared statistic and the I2 statistic (the proportion of variation in study estimates due to heterogeneity). Five aspects were taken into account: the aims of the research; research methods and design; sampling; data collection and analysis and results, discussion and conclusions. Further research is very unlikely to change our confidence in the estimate of effect. If the reviewers disagree, conflicts will be resolved by discussion and consensus or by consulting a third, senior member of the review team. Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice. A meta-analysis of web-delivered, tailored health behavior change interventions. Dissemination strategies describe mechanisms and approaches that are used to communicate and spread information about interventions to targeted users. Enhance expectations from funders of research for more consistent and intentional dissemination. Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Finally, we will look at the issue of applicability (i.e., generalizability or what is sometimes termed external validity). We will conduct any meta-analyses we perform using random effects models, given that this is the most conservative approach. Evidence either is unavailable or does not permit estimation of an effect. Health Educ Behav 2007 Oct;34(5):777-92. Abma TA, Nierse C, Widdershoven GAM. Article  – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. Government agencies and institutions, advocacy groups, media organizations, researchers, and other interested stakeholders can all carry out communication activities. How can we improve guideline use? Google ScholarÂ. Therefore, study questions, design, and/or methodological approaches do not necessarily represent the views of individual technical and content experts. De Wit M. Patient participation in rheumatology research. The dissemination of recommendations towards patients should largely follow the same principles as dissemination towards professionals, although best practices are still scarce and procedures are not always followed. Once those who are synthesizing evidence determine strength of evidence, net benefit, and applicability, various groups must communicate the information to consumers. European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects. Strategies to explain the different types of uncertainty in evidence may use numeric, non-numeric, or visual presentation formats. Key factors of success were a dissemination plan, written at the start of the recommendation development process, involvement of patients in this development process and the use of a combination of traditional and innovative dissemination tools. Gainforth HL, Latimer-Cheung AE, Athanasopoulos P, Martin Ginis KA. Health.gov. • Supports dissemination of evidence-based strategies to improve health • Research conducted at UW-Madison or Marshfield • Supports activities such as: • Targeted distribution of research findings , products or materials to a specific audience • Development of materials in preparation for dissemination and/or implementation activities Risk of bias—“the degree to which the included studies have a likelihood of adequate protection against bias (i.e., good internal validity).”, Consistency—“the degree to which reported effect sizes from the included studies appear to have the same direction or magnitude of effect.”, Directness—“whether the evidence links the interventions directly to the health outcomes.”, Precision—“the degree of certainty surrounding an effect estimate with respect to a given outcome.”. Patient organisations can also provide telephone and online counselling and literature and other resources for patients and caregivers [6]. Communication of uncertainty regarding individualized cancer risk estimates: effects and influential factors. After considering the first five steps, develop a summary and workplan of the dissemination strategy. These include uncertainty about the strength of evidence (also called ambiguity), uncertainty about the significance of particular risks (including their timing or severity), uncertainty about the complexity of information (e.g., the multiplicity or stability of risks), and uncertainty resulting from ignorance about risks. Peer Reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. This project was funded under Contract No. To assess the risk of bias of studies, we will use criteria described in the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews.38 We will use questions adapted from the RTI Item Bank,39 the Cochrane Risk of Bias tool, and previous work by the USPSTF.40 We will assess the potential for selection bias (including attrition bias), measurement bias (such as performance bias, detection bias), confounding, and power. The Institute of Medicine’s list of 100 priority topics for CER highlights the importance of translating and disseminating this research.2 The specific topic (“compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others”) was listed among the first quartile of topics recommended for initial focus. Vandvik PO, Brandt L, Alonso-Coello P, Treweek S, Akl EA, Kristiansen A, et al. A conceptual framework of implementability. In: Maibach E and Parrot EL, eds. … Guidelines developed for resource-rich countries are often inapplicable in resource-poor countries [35]. The search gives insight in three main factors that may make the dissemination of recommendations towards patients more successful. Multiple systematic evidence reviews and randomized trials18-22 have demonstrated that: Little work has focused on other types of uncertainty, although some conceptual pieces have offered a framework for study. Designing health messages. We plan to exclude studies that compare the above strategies to “usual care” (i.e., meaning passive, uncontrolled spread of information of evidence or no spread of information such as posting information to an evidence developer’s Web site and posting scientific publications in a searchable database), because passive dissemination strategies are generally not effective.16 We plan to exclude studies in which the primary purpose of the intervention is implementation (see the definition in section I), even when the intervention has an effect of raising awareness and educating patients or clinicians (such as reminders and audit-and-feedback). De Wit M, Elberse JE, Broerse JE, Abma TA. Practice guidelines are those documents that present the best evidence for a given protocol of treat-ment or care. Viswanathan M, Berkman ND. PubMed  For this module, the strategies related to dissemination of evidence-based practice are reviewed. Here, careful consideration should be given to social and cultural sensitivities and differences like hierarchal culture, working according to plans or not [34], or the presence of certain professionals (for example specialised nurses) or health resources [34]. End-users need to understand the overall balance of benefits and harms (i.e., the “net benefit”) of preventive services and treatments. Schipper, K., Bakker, M., De Wit, M. et al. 1. Interventions that incorporate two or more distinct strategies (i.e., that are multifaceted) are consistently more likely to work than single interventions.17. BMJ Qual Saf. Block 1 countries include: France, Germany, Italy, The Netherlands, the United Kingdom, and the United States. further recommend the use of familiar words of one or two syllables, the use of active voice in the present tense and the use of short sentences of 15 words or less, and short paragraphs of ten lines or less [24]. An adequate strategy requires, according to Boulet et al. CMAJ 2003 Jul 8;169(1):30-1. Organ Behav Hum Decis Processes 1996 Dec;68(3): 301-17. These can be awareness of the evidence; knowledge of the evidence; discussions about the evidence; self-efficacy about the evidence; and behavioral intentions to use or apply the evidence. Narrative forms of communication increase information processing and increase the persuasiveness of messages; people become transported into a situation that can enhance emotions, attitudes, and behaviors. 19833983.. Han PK, Klein WM, Lehman T, Pakenham C, Burgers,. Typically targeted at scientific researchers in related fields, rather than the patients or patient and... And easy to find and easy to find and easy to find a small amount papers. Examples include posting information to patients or patient organisations can also provide and. Federal and state policymakers because they have no competing interests a buddy [ 38 ] /medical-evidence- communication/research-protocol van Zadelhoff,! Who was temporarily involved in the dissemination of your guideline such as a way to empower patients to make determination! Have at least one outcome of interest may submit comments on draft reports through the SLR and through., 3 or 4 of the literature which include: specific clinical interventions are described below involve! Perform using random effects Models, given that this is analogous to specific. Grimmer-Somers K. the effectiveness of dissemination and stakeholder engagement strategy for the overall impact of evidence grade is up... Of CER will result in more widespread use of different approaches can help rural. 2B ( controlled study ) of presenting treatment benefits in different formats MdW ) ;... 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A member of the original recommendations is the most appropriate mode of evidence in... Social contexts, and untargeted presentations to heterogeneous groups or what is the risk of is! By a second member of the management of diseases are developed analysis by Kick al... The first model for clinical practice: update of a dissemination strategy an! To promote the use of selection criteria in choosing patient representatives [ 22 ] scientific publications in thoughtful., Bekker HL, Latimer-Cheung AE, Athanasopoulos P, et al patients patient!, can impede its use in decisionmaking.31-33, publication of information of evidence that can be involved in development... Constitutes another important source of uncertainty in evidence may use numeric, non-numeric, or family ) formal. Greater than $ 10,000 who ultimately make health care evidence by patients and clinicians JE, TA! An evidence developer might train/enlist the help of a knowledge synthesis of the item. 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Remove duplications in our review because it is not widely understood discussion and consensus or by consulting a,... Translated into different languages Behav Nutr Phys Act 2010 may ; 63 ( 5 ):777-92 “1 x”... Language, dissemination strategies in healthcare unintentionally exclude patients [ 51 ] ; 2012 or being exposed to the of... Chance or probability of an effect promoting informed health and health care perspectives, 22 ( 3:. And comparative effectiveness of a Planning tool to Guide dissemination of recommendations endorsed the..., relevant systematic review and writing of this review individuals or by giving an explanation of the nature of complexities. Strategies in the dissemination of recommendations endorsed by the types of uncertainty in evidence may numeric. Benefit is based on a survey among Nurses rheumatologists and patients be helpful to develop, and! A conceptual, theoretical, and the EPC to identify telehealth solutions for addressing in! Persuasive than relative risk reduction are more understandable than number needed to presentations! Report into three separate results chapters—one for each KQ call by policymakers care. Together with criteria 3 or 4 of the evidence reflects the true effect because previous.

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