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Advanced practice nursing in Canada: overview of a decision support synthesis.

https://arctichealth.org/en/permalink/ahliterature135441
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Publication Type
Article
Date
Dec-2010
Author
Alba DiCenso
Ruth Martin-Misener
Denise Bryant-Lukosius
Ivy Bourgeault
Kelley Kilpatrick
Faith Donald
Sharon Kaasalainen
Patricia Harbman
Nancy Carter
Sandra Kioke
Julia Abelson
R James McKinlay
Dianna Pasic
Brandi Wasyluk
Julie Vohra
Renee Charbonneau-Smith
Author Affiliation
Ontario Training Centre in Health Services & Policy Research, Nursing and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - classification - methods - organization & administration
Canada
Decision Support Systems, Clinical - classification - organization & administration
Focus Groups
Health Care Surveys
Health Policy
Humans
Leadership
Nurse Clinicians - classification - organization & administration
Nurse Practitioners - classification - organization & administration
Periodicals as Topic - statistics & numerical data
Publishing - statistics & numerical data
Abstract
The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.
PubMed ID
21478685 View in PubMed
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Alternatives to project-specific consent for access to personal information for health research: insights from a public dialogue.

https://arctichealth.org/en/permalink/ahliterature154140
Source
BMC Med Ethics. 2008;9:18
Publication Type
Article
Date
2008
Author
Donald J Willison
Marilyn Swinton
Lisa Schwartz
Julia Abelson
Cathy Charles
David Northrup
Ji Cheng
Lehana Thabane
Author Affiliation
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada. willison@mcmaster.ca
Source
BMC Med Ethics. 2008;9:18
Date
2008
Language
English
Publication Type
Article
Keywords
Adult
Canada
Choice Behavior
Confidentiality - standards
Consensus
Female
Humans
Informed Consent - ethics
Male
Middle Aged
Public Opinion
Questionnaires
Research Design
Abstract
The role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.
We conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.
Broad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.
Because no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research.
Notes
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Cites: BMC Med Ethics. 2003 Jan 3;4:E112513704
PubMed ID
19019239 View in PubMed
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Alternatives to project-specific consent for access to personal information for health research: what is the opinion of the Canadian public?

https://arctichealth.org/en/permalink/ahliterature161798
Source
J Am Med Inform Assoc. 2007 Nov-Dec;14(6):706-12
Publication Type
Article
Author
Donald J Willison
Lisa Schwartz
Julia Abelson
Cathy Charles
Marilyn Swinton
David Northrup
Lehana Thabane
Author Affiliation
Centre for Evaluation of Medicines, St. Joseph's Healthcare, 105 Main Street East, P1, Hamilton, Ontario, Canada. willison@mcmaster.ca
Source
J Am Med Inform Assoc. 2007 Nov-Dec;14(6):706-12
Language
English
Publication Type
Article
Keywords
Access to Information
Attitude to Health
Biomedical research
Canada
Confidentiality
Cross-Sectional Studies
Health Care Surveys
Humans
Medical Records
Medical Records Systems, Computerized
Public Opinion
Trust
Abstract
This study sought to determine public opinion on alternatives to project-specific consent for use of their personal information for health research.
The authors conducted a fixed-response random-digit dialed telephone survey of 1,230 adults across Canada.
We measured attitudes toward privacy and health research; trust in different institutions to keep information confidential; and consent choice for research use of one's own health information involving medical record review, automated abstraction of information from the electronic medical record, and linking education or income with health data.
Support was strong for both health research and privacy protection. Studying communicable diseases and quality of health care had greatest support (85% to 89%). Trust was highest for data institutes, university researchers, hospitals, and disease foundations (78% to 80%). Four percent of respondents thought information from their paper medical record should not be used at all for research, 32% thought permission should be obtained for each use, 29% supported broad consent, 24% supported notification and opt out, and 11% felt no need for notification or consent. Opinions were more polarized for automated abstraction of data from the electronic medical record. Respondents were more willing to link education with health data than income.
Most of the public supported alternatives to study-specific consent, but few supported use without any notification or consent. Consent choices for research use of one's health information should be documented in the medical record. The challenge remains how best to elicit those choices and ensure that they are up-to-date.
Notes
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Cites: Int J Med Inform. 2006 Jul;75(7):530-4116198142
Cites: BMC Med Ethics. 2006;7:E616716233
Cites: BMJ. 2006 Jul 29;333(7561):255-816873867
Cites: Soc Sci Med. 2007 Jan;64(1):223-3517045717
Cites: BMJ. 2001 Mar 24;322(7288):73011264225
PubMed ID
17712084 View in PubMed
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Assessing the impacts of citizen deliberations on the health technology process.

https://arctichealth.org/en/permalink/ahliterature108650
Source
Int J Technol Assess Health Care. 2013 Jul;29(3):282-9
Publication Type
Article
Date
Jul-2013
Author
Julia Abelson
Yvonne Bombard
François-Pierre Gauvin
Dorina Simeonov
Sarah Boesveld
Author Affiliation
Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Source
Int J Technol Assess Health Care. 2013 Jul;29(3):282-9
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Advisory Committees
Consumer Participation
Decision Making
Health Policy
Humans
Ontario
Qualitative Research
Social Values
Technology Assessment, Biomedical
Abstract
We assessed the impacts of a Citizens' Reference Panel on the deliberations of a provincial health technology advisory committee and its secretariat, which produce, recommendations for the use of health technologies in Ontario, Canada.
A fourteen-member citizens' reference panel was convened five times between February 2009 and May 2010 to participate in informed, facilitated discussions to inform the assessment of individual technologies and provincial health technology assessment processes more generally. Qualitative data collection methods were used to document observed and perceived impacts of the citizens' panel on the health technology assessment (HTA) process.
Panel impacts were observed for all technologies reviewed, at two different stages in the HTA process, and represented macro- (raising awareness) and micro-level (informing recommendations) impacts. These impacts were shaped by periodic opportunities for direct and brokered exchange between the Panel and the expert advisory committee to clarify roles, foster accountability, and build trust. Our findings offer new insights about one of the main considerations in the design of deliberative participatory structures-how to maintain the independence of a citizens' panel while ensuring that their input is considered at key junctures in the HTA process.
Citizens' panels can exert various impacts on the HTA process. Ensuring these types of structures include opportunities for direct exchange between citizens and experts, to clarify roles, promote accountability, and build trust will facilitate their impacts in a variety of settings.
Notes
Erratum In: Int J Technol Assess Health Care. 2013 Oct;29(4):466
PubMed ID
23863188 View in PubMed
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Bringing 'the public' into health technology assessment and coverage policy decisions: from principles to practice.

https://arctichealth.org/en/permalink/ahliterature167360
Source
Health Policy. 2007 Jun;82(1):37-50
Publication Type
Article
Date
Jun-2007
Author
Julia Abelson
Mita Giacomini
Pascale Lehoux
Francois-Pierre Gauvin
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Health Sciences Centre, Hamilton Ontario, Canada. abelsonj@mcmaster.ca
Source
Health Policy. 2007 Jun;82(1):37-50
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Consumer Participation
Humans
Insurance Coverage
National health programs - organization & administration
Policy Making
Quebec
Technology Assessment, Biomedical
Abstract
Those making health care coverage decisions rely on health technology assessment (HTA) for crucial technical information. But coverage decision-making, and the HTA that informs it, are also inherently political. They involve the values and judgments of a range of stakeholders as well as the public. Moreover, governments are politically accountable for their resource allocation decisions. Canadian policy makers are at an early stage in the design of legitimate mechanisms for the public to contribute to, and to be apprised of, HTA and coverage decisions. As they consider the options, questions arise about whom to involve (e.g., which publics), how to engage them (e.g., through what public involvement or accountability mechanisms), and for what purpose (e.g., to inform the public of decisions and their rationales, or to have the public directly affect those decisions). Often key concepts, such as the difference between public accountability and public participation, are not well articulated or distinguished in these debates. Guidance is needed regarding both rationales and methods for involving the public in HTA and technology coverage decisions. We offer a framework that clearly distinguishes specific roles for the public, and relates them to several layers of policy analysis and policy making where 'the public' may engage in different tasks. The framework offers a menu of choices for policy makers contemplating changes to public involvement, as well as a model that can be used to characterize and analyze different approaches across jurisdictions.
PubMed ID
16996637 View in PubMed
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Canadians confront health care reform.

https://arctichealth.org/en/permalink/ahliterature179975
Source
Health Aff (Millwood). 2004 May-Jun;23(3):186-93
Publication Type
Article
Author
Julia Abelson
Matthew Mendelsohn
John N Lavis
Steven G Morgan
Pierre-Gerlier Forest
Marilyn Swinton
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario. abelsonj@mcmaster.ca
Source
Health Aff (Millwood). 2004 May-Jun;23(3):186-93
Language
English
Publication Type
Article
Keywords
Canada
Data Collection
Delivery of Health Care - organization & administration - standards
Health Care Reform
Health Services Accessibility
Humans
National Health Programs
Public Opinion
Abstract
In 2002 Canadians were less anxious about the state of their health care system than they were a few years earlier, when perceptions peaked that the system needed major reform. They expressed strong support in 2002 for maintaining the status quo on health care financing (that is, no user fees and no two-tier care) within the traditional domains of physician and hospital care. But they appeared more receptive to two-tier care and for-profit delivery for the newer and rapidly expanding domains of home care and high-tech care.
PubMed ID
15160816 View in PubMed
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Does deliberation make a difference? Results from a citizens panel study of health goals priority setting.

https://arctichealth.org/en/permalink/ahliterature183618
Source
Health Policy. 2003 Oct;66(1):95-106
Publication Type
Article
Date
Oct-2003
Author
Julia Abelson
John Eyles
Christopher B McLeod
Patricia Collins
Colin McMullan
Pierre-Gerlier Forest
Author Affiliation
Centre for Health Economics and Policy Analysis, Health Sciences Centre, Rm 3H28, McMaster University, 1200 Main Street West, Hamilton, Ont., Canada L8N 3Z5. abelsonj@mcmaster.ca
Source
Health Policy. 2003 Oct;66(1):95-106
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Consumer Participation - psychology - statistics & numerical data
Decision Making
Female
Health Priorities
Humans
Male
Middle Aged
Ontario
Organizational Objectives
Policy Making
Public Opinion
Questionnaires
Abstract
How to involve the public in setting health and health care priorities is a constant challenge for health system decisions. Policy maker interest in involving the public in increasingly complex and value-laden priority setting processes has led to the use of deliberative public involvement methods designed to promote discussion and debate among participants with the objective of obtaining more informed and consensual views. These methods have not been evaluated rigorously using controlled designs with pre- and post-test measurements. We examined, using a controlled design, the effects of introducing different opportunities for deliberation into a process for obtaining public input into a community health goals priority setting process. Our findings indicate that deliberation does make a difference to participant views. As more deliberation is introduced, participant views may be more amenable to change. Deliberation also offers the potential for views to become more rather than less entrenched. While we are beginning to understand the difference deliberation makes to participant views, we are still at an early stage in understanding the process through which these differences come about and what difference deliberation makes to broader outcomes such as civic competence, civic engagement and health policy decisions.
PubMed ID
14499168 View in PubMed
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Eliciting ethical and social values in health technology assessment: A participatory approach.

https://arctichealth.org/en/permalink/ahliterature133800
Source
Soc Sci Med. 2011 Jul;73(1):135-44
Publication Type
Article
Date
Jul-2011
Author
Yvonne Bombard
Julia Abelson
Dorina Simeonov
Francois-Pierre Gauvin
Author Affiliation
Department of Health Policy Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, Canada M5T 3M6. yvonne.bombard@utoronto.ca
Source
Soc Sci Med. 2011 Jul;73(1):135-44
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Community-Based Participatory Research
Female
Health Policy
Humans
Male
Middle Aged
Ontario
Questionnaires
Social Values
Technology Assessment, Biomedical - ethics
Young Adult
Abstract
Despite a growing consensus that ethical and social values should be addressed in health technology assessment (HTA) processes, there exist a variety of methods for doing so. There is growing interest in involving citizens in policy development to ensure that decisions are legitimate, and reflect the broad social values of the public. We sought to bring these issues together by employing a participatory approach to elicit ethical and social values in HTA. Our primary objective was to elicit a set of ethical and social values from citizens that could be used to guide Ontario's HTA evidentiary review and appraisal process. A secondary objective was to explore the feasibility of using participatory approaches to elicit these values. A 14-person Citizens' Reference Panel on Health Technologies was established to provide input to the Ontario Health Technology Advisory Committee in developing its recommendations. A mixed methods approach was used where informed, deliberative discussions were combined with pre- and post-questionnaires, which assessed the relative importance of various ethical and social values as well as their stability over time. Over the course of five meetings, panel members progressed toward the identification of a set of core values -universal access, choice and quality care. These values were consistently prioritized as the core values that should be considered in the evaluation of health technologies and ensuing recommendations. Sustained and deliberative methods, like a citizens' panel, offer a promising approach for eliciting ethical and social values into HTA.
PubMed ID
21664018 View in PubMed
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Examining the role of context in the implementation of a deliberative public participation experiment: results from a Canadian comparative study.

https://arctichealth.org/en/permalink/ahliterature164586
Source
Soc Sci Med. 2007 May;64(10):2115-28
Publication Type
Article
Date
May-2007
Author
Julia Abelson
Pierre-Gerlier Forest
John Eyles
Ann Casebeer
Elisabeth Martin
Gail Mackean
Author Affiliation
McMaster University Hamilton, Ontario, Canada. abelsonj@mcmaster.ca
Source
Soc Sci Med. 2007 May;64(10):2115-28
Date
May-2007
Language
English
Publication Type
Article
Keywords
Canada
Consumer Participation
Decision Making
Evidence-Based Medicine
Female
Focus Groups
Health Services Research
Humans
Interviews as Topic
Male
Abstract
To resolve tensions among competing sources of evidence and public expectations, health-care managers and policy makers are turning more than ever to involve the public in a wide range of decisions. Yet efforts to use research evidence to inform public involvement decisions are hampered by an absence of rigorous public participation evaluation research. In particular, greater rigour in exploring the roles played by different contextual variables--such as characteristics of the issue of interest, the culture of the sponsoring organization and attributes of the decision being made--is needed. Using a comparative quasi-experimental design, we assessed the performance of a generic public participation method implemented in 5 Canadian regionalized health settings between 2001 and 2004. Participant and decision-maker perspectives were assessed and, through direct observation, the roles exerted by contextual variables over the public involvement processes were documented and analysed. Our findings demonstrate that a generic public participation method can be implemented in a variety of contexts and with considerable success. Context exerts fostering and inhibiting influences that contribute to more (or less) successful implementation. Public participation practitioners are encouraged to pay careful attention to the types of issues and decisions for which they are seeking public input. Sufficient organizational resources and commitment to the goals of the public participation process are also required. Attention to these contextual attributes and their influence on the design and outcomes of public participation processes is as important as choosing the "right" public participation mechanism.
PubMed ID
17368680 View in PubMed
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Examining the role of health services research in public policymaking.

https://arctichealth.org/en/permalink/ahliterature190707
Source
Milbank Q. 2002;80(1):125-54
Publication Type
Article
Date
2002
Author
John N Lavis
Suzanne E Ross
Jeremiah E Hurley
Joanne M Hohenadel
Gregory L Stoddart
Christel A Woodward
Julia Abelson
Author Affiliation
McMaster University, Institute for Work & Health, Canadian Institute for Advanced Research. lavisj@mcmaster.ca
Source
Milbank Q. 2002;80(1):125-54
Date
2002
Language
English
Publication Type
Article
Keywords
Advisory Committees
Decision Making, Organizational
Evidence-Based Medicine
Health Knowledge, Attitudes, Practice
Health Policy
Health Services Research - utilization
Humans
Ontario
Policy Making
Public Health Administration
Sampling Studies
Saskatchewan
Abstract
Conceptual, methodological, and practical issues await those who seek to understand how to make better use of health services research in developing public policy. Some policies and some policymaking processes may lend themselves particularly well to being informed by research. Different conclusions about the extent to which policymaking is informed by research may arise from different views about what constitutes health services research (is it citable research or any professional social inquiry that can aid in problem solving?) or different views about what constitutes research use (is it explicit uses of research only, or does it also include tacit knowledge or the positions of stakeholders when they are informed by research and are influential in the policymaking process?). Some conditions may favor the use of research in policymaking, like sustained interactions between researchers and policymakers. Results from an exploratory study on the use of health services research by Canadian provincial policymakers illustrate these issues.
Notes
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PubMed ID
11933791 View in PubMed
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24 records – page 1 of 3.