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      Engagement of older adults with multimorbidity as patient research partners: Lessons from a patient-oriented research program

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          Abstract

          Background:

          Patient “engagement” in health research broadly refers to including people with lived experience in the research process. Although previous reviews have systematically summarized approaches to engaging older adults and their caregivers in health research, there is currently little guidance on how to meaningfully engage older adults with multimorbidity as research partners.

          Objectives:

          This paper describes the lessons learned from a patient-oriented research program, the Aging, Community and Health Research Unit (ACHRU), on how to engage older adults with multimorbidity as research partners. Over the past 7-years, over 40 older adults from across Canada have been involved in 17 ACHRU projects as patient research partners.

          Methods:

          We developed this list of lessons learned through iterative consensus building with ACHRU researchers and patient partners. We then met to collectively identify and summarize the reported successes, challenges and lessons learned from the experience of engaging older adults with multimorbidity as research partners.

          Results:

          ACHRU researchers reported engaging older adult partners across many phases of the research process. Five challenges and lessons learned were identified: 1) actively finding patient partners who reflect the diversity of older adults with multimorbidity, 2) developing strong working relationships with patient partners, 3) providing education and support for both patient partners and researchers, 4) using flexible approaches for engaging patients, and 5) securing adequate resources to enable meaningful engagement.

          Conclusion:

          The lessons learned through this work may provide guidance to researchers on how to facilitate meaningful engagement of this vulnerable and understudied subgroup in the patient engagement literature.

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          Most cited references45

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          Aging with multimorbidity: a systematic review of the literature.

          A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients. Copyright © 2011 Elsevier B.V. All rights reserved.
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            Patient engagement in research: a systematic review

            Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed.
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              A systematic review of the impact of patient and public involvement on service users, researchers and communities.

              Patient and public involvement (PPI) in research has expanded nationally and internationally over the last decade, and recently there has been significant attention given to understanding its impact on research. Less attention has been given to the impact of PPI on the people involved, yet it has been shown that the success of PPI in research can be reliant on the processes of engagement between these individuals and communities. This paper therefore critically explores the impact of PPI on service users, researchers and communities involved in health and social care research.
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                Author and article information

                Journal
                J Comorb
                J Comorb
                COB
                spcob
                Journal of Comorbidity
                SAGE Publications (Sage UK: London, England )
                2235-042X
                17 March 2021
                Jan-Dec 2021
                : 11
                : 2633556521999508
                Affiliations
                [1 ]School of Nursing, McMaster University, Hamilton, Ontario, Canada
                [2 ]Health Research Methods, Evidence and Impact, Ringgold 62703, Faculty of Health Sciences, McMaster University; , Hamilton, Ontario, Canada
                [3 ]Aging, Community and Health Research Unit, Ringgold 62703, Faculty of Health Sciences, McMaster University; , Hamilton, Ontario, Canada
                [4 ]McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
                [5 ]Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
                [6 ]School of Public Health and Health Systems, Ringgold 8430, University of Waterloo; , Waterloo, Ontario, Canada
                [7 ]Schlegel-UW Research Institute for Aging, Ringgold 8430, University of Waterloo; , Waterloo, Ontario, Canada
                [8 ]Murray Alzheimer Research & Education Program (MAREP), Ringgold 8430, University of Waterloo; , Waterloo, Ontario, Canada
                Author notes
                [*]Maureen Markle-Reid, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1, HSC 3N25B. Email: mreid@ 123456mcmaster.ca
                Author information
                https://orcid.org/0000-0002-4019-7077
                https://orcid.org/0000-0002-7566-8932
                https://orcid.org/0000-0001-8168-8449
                https://orcid.org/0000-0002-7864-344X
                https://orcid.org/0000-0002-3117-0542
                Article
                10.1177_2633556521999508
                10.1177/2633556521999508
                7975523
                85489ccf-8816-49cc-8c83-26c6f818ad40
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 14 January 2021
                : 14 January 2021
                : 29 January 2021
                Funding
                Funded by: Ontario SPOR Support Unit IMPACT award;
                Award ID: 60502
                Categories
                Article
                Custom metadata
                January-December 2021
                ts3

                patient engagement,patient-oriented research,older adults,multimorbidity,health intervention

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