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Derivation of Patient-Defined Adverse Cardiovascular and Noncardiovascular Events Through a Modified Delphi Process
- Source :
- JAMA Network Open
- Publication Year :
- 2021
- Publisher :
- American Medical Association (AMA), 2021.
-
Abstract
- Key Points Question Which adverse cardiovascular and noncardiovascular events are most relevant to patients? Findings In this qualitative study of patients with advanced cardiovascular diseases and their caregivers and clinicians, a consensus-based definition of patient-defined adverse cardiovascular and noncardiovascular events (PACE) was reached using a modified Delphi process; the definition included severe stroke necessitating hospitalization for 14 days or more or inpatient rehabilitation, ventilator dependence, new onset or worsening heart failure, nursing home admission, and new onset dialysis. Meaning Given the paucity of patient-centered outcomes in cardiovascular research, the concept of PACE may be applied in future epidemiological and intervention studies to ensure that management of cardiovascular disease is founded on outcomes that are important and relevant to patients, caregivers, and clinicians.<br />This qualitative study attempts to derive patient-defined adverse cardiovascular and noncardiovascular events through a modified Delphi consensus-based process involving panel discussions with patients and their caregivers and clinicians.<br />Importance There is little evidence to support patient-centered outcomes in patients with cardiovascular disease. Objective To derive patient-defined adverse cardiovascular and noncardiovascular events (PACE) through a consensus-based process. Design, Setting, and Participants This pan-Canadian, consensus-based, qualitative study used an iterative Delphi method to achieve consensus within a 35-member panel consisting of patients with cardiovascular diseases and their caregivers and clinicians. The process included 4 rounds of online questionnaires, followed by an in-person final consensus meeting. Data analysis was performed in September 2019. Main Outcomes and Measures Defining PACE as a 5-item composite outcome. Results Thirty-five potential panelists consented to participate, including 11 clinicians (8 men [73%]) and 24 patients and caregivers (13 men [54%]). Twenty-nine (83%), 28 (80%), 26 (74%), and 23 (66%) of the panelists participated in each of respective the online rounds. A shortlist of 11 patient-defined items was further refined at the in-person meeting, which 20 of the panelists attended. The PACE definition that was decided through the consensus process was a composite of severe stroke necessitating hospitalization for 14 days or longer or inpatient rehabilitation, ventilator dependence, new onset or worsening heart failure, nursing home admission, or new onset dialysis. Conclusions and Relevance This study defined PACE as a versatile, patient-centered outcome through a consensus process with input from patients, caregivers, and clinicians. Given the paucity of patient-centered outcomes in cardiovascular research, PACE may be considered as a potential outcome after methodological evaluation of its reliability.
- Subjects :
- Adult
Male
Canada
medicine.medical_specialty
Consensus
Delphi Technique
medicine.medical_treatment
Delphi method
Disease
Computer-assisted web interviewing
Renal Dialysis
Physicians
medicine
Humans
Patient Reported Outcome Measures
Qualitative Research
Dialysis
Original Investigation
Pace
Heart Failure
Rehabilitation
business.industry
Research
General Medicine
Respiration, Artificial
Nursing Homes
Hospitalization
Stroke
Online Only
Caregivers
Cardiovascular Diseases
Emergency medicine
Surgery
Female
Hemodialysis
business
Qualitative research
Subjects
Details
- ISSN :
- 25743805
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- JAMA Network Open
- Accession number :
- edsair.doi.dedup.....ad920fe6216228c403a4f435f2a41ba2