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      Evaluating the “return on patient engagement initiatives” in medicines research and development: A literature review

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          Abstract

          Background

          Showing how engagement adds value for all stakeholders can be an effective motivator for broader implementation of patient engagement. However, it is unclear what methods can best be used to evaluate patient engagement. This paper is focused on ways to evaluate patient engagement at three decision‐making points in the medicines research and development process: research priority setting, clinical trial design and early dialogues with regulators and health technology assessment bodies.

          Objective

          Our aim was to review the literature on monitoring and evaluation of patient engagement, with a focus on indicators and methods.

          Search strategy and inclusion criteria

          We undertook a scoping literature review using a systematic search, including academic and grey literature with a focus on evaluation approaches or outcomes associated with patient engagement. No date limits were applied other than a cut‐off of publications after July 2018.

          Data extraction and synthesis

          Data were extracted from 91 publications, coded and thematically analysed.

          Main results

          A total of 18 benefits and 5 costs of patient engagement were identified, mapped with 28 possible indicators for their evaluation. Several quantitative and qualitative methods were found for the evaluation of benefits and costs of patient engagement.

          Discussion and conclusions

          Currently available indicators and methods are of some use in measuring impact but are not sufficient to understand the pathway to impact, nor whether interaction between researchers and patients leads to change. We suggest that the impacts of patient engagement can best be determined not by applying single indicators, but a coherent set of measures.

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          Most cited references60

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          Guidance for conducting systematic scoping reviews.

          Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
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            Evaluating patient and stakeholder engagement in research: moving from theory to practice.

            Despite the growing demand for research that engages stakeholders, there is limited evidence in the literature to demonstrate its value - or return on investment. This gap indicates a general lack of evaluation of engagement activities. To adequately inform engagement activities, we need to further investigate the dividends of engaged research, and how to evaluate these effects. This paper synthesizes the literature on hypothesized impacts of engagement, shares what has been evaluated and identifies steps needed to reduce the gap between engagement's promises and the underlying evidence supporting its practice. This assessment provides explicit guidance for better alignment of engagement's promised benefits with evaluation efforts and identifies specific areas for development of evaluative measures and better reporting processes.
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              ‘Is it worth doing?’ Measuring the impact of patient and public involvement in research

              Abstract Much of the current debate around the impact of patient/public involvement on research focuses on the lack of empirical data. While a number of systematic literature reviews have reported the various ways in which involvement makes a difference to research and the people involved, this evidence has been criticised as being weak and anecdotal. It is argued that robust evidence is still required. This review reflects on the use of quantitative approaches to evaluating impact. It concludes that the statistical evidence is weakened by not paying sufficient attention to the context in which involvement takes place and the way it is carried out. However, if scientific (systematic, quantitative, empirical) approaches are designed in a way to take these factors into account, they might not generate knowledge that is useful beyond the original context. Such approaches might not therefore enhance our understanding of when, why and how involvement makes a difference. In the context of individual research projects where researchers collaborate with patients/the public, researchers often acquire ‘new’ knowledge about life with a health condition. This new understanding can be described as experiential knowledge—‘knowledge in context’—that researchers gain through direct experience of working with patients/the public. On this basis, researchers’ accounts of their experience potentially provide a source of insight and learning to influence others, in the same way that the patient experience helps to shape research. These accounts could be improved by increasing the detail provided about context and mechanism. One of the most important contextual factors that influence the outcome of involvement is the researchers themselves and the skills, assumptions, values and priorities they start with. At the beginning of any research project, the researchers ‘don’t know what they don’t know’ until they involve patients/the public. This means that the impact of involvement within any particular project is somewhat unpredictable. The answer to the question ‘Is involvement worth doing?’ will always be ‘It depends’. Further exploration of the contextual and mechanistic factors which influence outcomes could give a stronger steer to researchers but may never accurately predict any specific impact. Plain English summary In recent years, there has been considerable interest in finding out what difference patient and public involvement makes to research projects. The evidence published so far has been criticised for being weak and anecdotal. Some people argue we need robust evidence of impact from scientific studies of involvement. In this review, I consider examples of where impact has been measured using statistical methods. I conclude that the statistical evidence is weak, if the studies do not consider the context in which involvement takes place and the way that it is done. Studies designed to take this into account give us more confidence that the involvement did make a difference to that particular project. They do not tell us whether the same impact will occur in the same way in other projects and therefore have limited value. Researchers gain an understanding of involvement through their direct experience of working with patients and the public. This is ‘knowledge in context’ or ‘insight’ gained in the same way that patients gain expertise through their direct experience of a health condition. This means that detailed accounts of involvement from researchers already provide valuable learning to others, in the same way that patients’ insights help shape research. However, the impact of involvement will always be somewhat unpredictable, because at the start of any project researchers ‘don’t know what they don’t know’—they do not know precisely what problems they might anticipate, until the patients/public tell them.
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                Author and article information

                Contributors
                Role: Researcherl.e.vat@vu.nl
                Role: Researcher
                Role: Assistant Professor
                Role: Researcher
                Role: European Lead Patient Innovation
                Role: PARADIGM Coordinator
                Role: Project Officer
                Role: Patient Engagement Senior Manager
                Role: Therapeutic Development Director
                Role: Senior Account Director
                Role: Benefit Risk Expert
                Role: Project Manager
                Role: Senior Director
                Role: Professor
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                06 September 2019
                February 2020
                : 23
                : 1 ( doiID: 10.1111/hex.v23.1 )
                : 5-18
                Affiliations
                [ 1 ] Athena Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
                [ 2 ] Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
                [ 3 ] MSD (Merck Sharp & Dohme) London UK
                [ 4 ] European Patients' Forum (EPF) Brussels Belgium
                [ 5 ] Alzheimer Europe Luxembourg Luxembourg
                [ 6 ] EURORDIS – Rare Diseases Europe Paris France
                [ 7 ] Nexgen Healthcare Communications London UK
                [ 8 ] Sanofi Chilly-Mazarin France
                [ 9 ] Lilly Nederland BV Utrecht The Netherlands
                [ 10 ] Merck Healthcare KGaA Darmstadt Germany
                Author notes
                [*] [* ] Correspondence

                Lidewij Eva Vat, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

                Email: l.e.vat@ 123456vu.nl

                Author information
                https://orcid.org/0000-0003-0077-6602
                https://orcid.org/0000-0003-2538-8366
                https://orcid.org/0000-0001-5158-581X
                https://orcid.org/0000-0003-4957-0189
                https://orcid.org/0000-0002-2606-776X
                https://orcid.org/0000-0002-8478-3422
                Article
                HEX12951
                10.1111/hex.12951
                6978865
                31489988
                498fcd8e-9933-403f-8269-19575b6a43fe
                © 2019 The Authors Health Expectations published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 March 2019
                : 02 July 2019
                : 17 July 2019
                Page count
                Figures: 1, Tables: 6, Pages: 14, Words: 10745
                Funding
                Funded by: Innovative Medicines Initiative (IMI) , open-funder-registry 10.13039/501100010767;
                Award ID: 777450
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                February 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:24.01.2020

                Health & Social care
                evaluation,framework,impact,literature review,medicines development,metrics,patient and public involvement,patient engagement,patient participation,research

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