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      Development of a Core Outcome Set for Studies on Obesity in Pregnant Patients (COSSOPP): a study protocol

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          Abstract

          Background

          Maternal obesity is a risk factor for adverse maternal, fetal, and neonatal events. Numerous clinical trials are currently exploring the effectiveness of antenatal and peripartum interventions in improving pregnancy outcomes that can in future inform clinical practice. However, the heterogeneity in outcome reporting limits our ability to compare outcomes across studies, and there is a lack of stakeholder representation in outcome choice. A pragmatic solution to this problem is the development of a core outcome set (COS) that defines the minimum criteria for outcome reporting in clinical trials undertaken in this population, arrived at by the involvement of relevant stakeholders.

          Methods

          The development of a COS for studies on obesity in pregnant patients (COSSOPP) will comprise five steps. First, a systematic review of published literature will identify the long list of outcomes, their definitions and measurements if applicable, and outcome reporting quality. This will be followed by a meta-synthesis of qualitative studies with patients, and qualitative interviews in Toronto with patients, clinicians, researchers, hospital administrators, and policy-makers, to identify novel outcomes that were not obtained through systematic review. Third, the long list of outcomes will be narrowed down through online Delphi surveys involving an international group of patients and relevant stakeholders. This will be followed by a face-to-face consensus meeting with representatives of all stakeholder groups to arrive at a consensus on the final COS. Finally, in order to determine how the identified core outcomes should be measured, we will conduct another literature review and Delphi process.

          Discussion

          COSSOPP will engage patients, clinicians, researchers, and other relevant stakeholders in determining the core set of outcomes that should be reported and measured in order to harmonize outcome reporting in studies evaluating the effectiveness of antepartum and peripartum interventions in obese pregnant women. This protocol provides a detailed overview of the steps involved in the development of a COS, to guide researchers in developing COS within their areas of specialization.

          COMET Core Outcome Set Registration

          http://www.comet-initiative.org/studies/details/939.

          Electronic supplementary material

          The online version of this article (10.1186/s13063-018-3029-1) contains supplementary material, which is available to authorized users.

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          Most cited references17

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          Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.

          Despite nursing's enthusiastic endorsement of the applicability of qualitative research approaches to answering relevant clinical questions, many nurse researchers have been hesitant to depart from traditional qualitative research methods. While various derivations of phenomenology, grounded theory, and ethnography have been popularized within qualitative nursing research, the methodological principles upon which these approaches are based reflect the foundations and objectives of disciplines whose aims are sometimes quite distinct from nursing's domain of inquiry. Thus, as many nurse researchers have discovered, nursing's unique knowledge mandate may not always be well served by strict adherence to traditional methods as the "gold standard" for qualitative nursing research. The authors present the point of view that a non-categorical description, drawing on principles grounded in nursing's epistemological mandate, may be an appropriate methodological alternative for credible research toward the development of nursing science. They propose a coherent set of strategies for conceptual orientation, sampling, data construction, analysis, and reporting by which nurses can use an interpretive descriptive approach to develop knowledge about human health and illness experience phenomena without sacrificing the theoretical or methodological integrity that the traditional qualitative approaches provide.
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            How to select outcome measurement instruments for outcomes included in a “Core Outcome Set” – a practical guideline

            Background In cooperation with the Core Outcome Measures in Effectiveness Trials (COMET) initiative, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative aimed to develop a guideline on how to select outcome measurement instruments for outcomes (i.e., constructs or domains) included in a “Core Outcome Set” (COS). A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. Methods Informed by a literature review to identify potentially relevant tasks on outcome measurement instrument selection, a Delphi study was performed among a panel of international experts, representing diverse stakeholders. In three consecutive rounds, panelists were asked to rate the importance of different tasks in the selection of outcome measurement instruments, to justify their choices, and to add other relevant tasks. Consensus was defined as being achieved when 70 % or more of the panelists agreed and when fewer than 15 % of the panelists disagreed. Results Of the 481 invited experts, 120 agreed to participate of whom 95 (79 %) completed the first Delphi questionnaire. We reached consensus on four main steps in the selection of outcome measurement instruments for COS: Step 1, conceptual considerations; Step 2, finding existing outcome measurement instruments, by means of a systematic review and/or a literature search; Step 3, quality assessment of outcome measurement instruments, by means of the evaluation of the measurement properties and feasibility aspects of outcome measurement instruments; and Step 4, generic recommendations on the selection of outcome measurement instruments for outcomes included in a COS (consensus ranged from 70 to 99 %). Conclusions This study resulted in a consensus-based guideline on the methods for selecting outcome measurement instruments for outcomes included in a COS. This guideline can be used by COS developers in defining how to measure core outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1555-2) contains supplementary material, which is available to authorized users.
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              Core Outcome Set-STAndards for Development: The COS-STAD recommendations

              Background The use of core outcome sets (COS) ensures that researchers measure and report those outcomes that are most likely to be relevant to users of their research. Several hundred COS projects have been systematically identified to date, but there has been no formal quality assessment of these studies. The Core Outcome Set-STAndards for Development (COS-STAD) project aimed to identify minimum standards for the design of a COS study agreed upon by an international group, while other specific guidance exists for the final reporting of COS development studies (Core Outcome Set-STAndards for Reporting [COS-STAR]). Methods and findings An international group of experienced COS developers, methodologists, journal editors, potential users of COS (clinical trialists, systematic reviewers, and clinical guideline developers), and patient representatives produced the COS-STAD recommendations to help improve the quality of COS development and support the assessment of whether a COS had been developed using a reasonable approach. An open survey of experts generated an initial list of items, which was refined by a 2-round Delphi survey involving nearly 250 participants representing key stakeholder groups. Participants assigned importance ratings for each item using a 1–9 scale. Consensus that an item should be included in the set of minimum standards was defined as at least 70% of the voting participants from each stakeholder group providing a score between 7 and 9. The Delphi survey was followed by a consensus discussion with the study management group representing multiple stakeholder groups. COS-STAD contains 11 minimum standards that are the minimum design recommendations for all COS development projects. The recommendations focus on 3 key domains: the scope, the stakeholders, and the consensus process. Conclusions The COS-STAD project has established 11 minimum standards to be followed by COS developers when planning their projects and by users when deciding whether a COS has been developed using reasonable methods.
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                Author and article information

                Contributors
                rachel.dadouch@mail.utoronto.ca
                mina.faheim@mail.utoronto.ca
                juandopratsc@smh.ca
                parsonsj@smh.ca
                +1-416-586-4800 , Rohan.DSouza@sinaihealthsystem.ca
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                27 November 2018
                27 November 2018
                2018
                : 19
                : 655
                Affiliations
                [1 ]Institute of Medical Science, University of Toronto7, Toronto, Canada
                [2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, MD Program, , University of Toronto, ; Toronto, Canada
                [3 ]GRID grid.415502.7, Applied Health Research Centre, Li Ka Shing Knowledge Institute, , St. Michael’s Hospital, ; Toronto, Canada
                [4 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Physical Therapy, , University of Toronto, ; Toronto, Canada
                [5 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, , Mount Sinai Hospital, University of Toronto, ; 3-908 – 700 University Avenue, Toronto, ON M5G 1Z5 Canada
                Author information
                http://orcid.org/0000-0002-4049-2017
                Article
                3029
                10.1186/s13063-018-3029-1
                6258169
                30482249
                0824626c-518a-450a-aa15-f67f22c1590a
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 July 2018
                : 30 October 2018
                Funding
                Funded by: Mount Sinai Hospital
                Funded by: Institute of Medical Science, University of Toronto
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2018

                Medicine
                core outcome set,obesity,pregnancy,childbirth,stakeholder,patient-reported outcomes,outcome reporting,qualitative research,consensus,delphi

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