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The Evidence Speaks

The Evidence Speaks (May 2020)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Dong H, Hayashi K, Milloy M-J, DeBeck K, Singer J, Wong H, Wood E, Kerrad T. Changes in substance use in relation to opioid agonist therapy among people who use drugs in a Canadian setting. Drug Alcohol Depend. 2020 Apr 25 epub ahead of print.

Opioid agonist therapy (OAT; methadone or buprenorphine/naloxone) has been shown to be effective in reducing opioid use, which in turn can help protect against opioid-related harms and improve quality of life. While its benefits are clear with regard to opioid use, it is unclear how OAT could impact the use of other substances. CHÉOS Scientists Drs. Joel Singer and Hubert Wong joined a team of B.C. researchers to investigate the changes in use of different substances by comparing long-term substance use patterns before and after initiating OAT. The researchers used data from three ongoing studies: the Vancouver Injection Drug Users Study (VIDUS), AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), and the At-Risk Youth Study (ARYS). The results demonstrated that there was a reduction in the use of illicit opioids, further supporting OAT use in this context. However, there was no significant change in the use of cocaine, crack cocaine, crystal methamphetamine, or cannabis. Furthermore, the researchers note that the increasing problematic use of alcohol may have an impact on the safety and effectiveness of OAT. They conclude that comprehensive treatment strategies would be desirable to help enhance the safety and effectiveness of OAT for people who use multiple substances.

Venis J, Dodek P. Feasibility and Acceptability of a Palliative Approach Screening Tool in the Intensive Care Unit. Am J Crit Care. 2020 May 1;29(3):214-20.

The palliative approach involves employing palliative care principles, such as promoting hope, dignity, comfort, and relieving suffering to improve the quality of life for people at all stages of a life-limiting illness. In the critical care environment, a focus on saving or curing seriously ill patients can make integrating the palliative approach difficult. CHÉOS Scientist Dr. Peter Dodek collaborated with Jane Vernis, nursing faculty instructor at British Columbia Institute of Technology, to investigate how palliative care is addressed in an intensive care unit (ICU) and to develop a screening tool for unmet needs that could be met through the palliative approach. The research was conducted in a 15-bed medical/surgical ICU at St. Paul’s Hospital, Vancouver, and all members of the ICU team were invited to help develop the tool. The approach used to develop the tool involved two focus groups, a quantitative survey, and two periods of pilot testing with interviews, and revisions to the tool following each testing period. Unlike other published tools, the tool developed in this study includes instructions on when and how often the tool should be used, selected needs criteria, suggested action items, and a section for tracking documentation of discussions that can be applied to all ICU patients. The tool also includes discussion prompts for nurses to consider, and promotes collaboration among the health care team. The investigators concluded that it is possible to develop a screening tool for unmet palliative care needs among ICU patients. Furthermore, the tool may contribute to systematic integration of the palliative approach into routine care for critically ill patients.

Carter SA, Gutman T, Logeman C, Cattran D, Lightstone L, Bagga A, Barbour SJ, et al. Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers. Clin J Am Soc Nephrol. 2020 May 7;15(5):673-84.

The management of glomerular disease can be difficult as its course can be unpredictable, plus it is unclear what disease and treatment outcomes are most important to patients. CHÉOS Scientist Dr. Sean Barbour joined an international group of researchers to investigate precisely what outcomes patients with glomerular disease and their caregivers prioritize. The researchers recruited 101 patients and 22 caregivers across Australia, Hong Kong, the United Kingdom, and the United States. Overall, the participants identified 58 different outcomes; these were ranked in order of prioritization. The patients and caregivers gave the highest priority to the outcomes of kidney function and mortality. The participants also prioritized patient-reported outcomes, including fatigue, anxiety, and life participation, which are typically less well reported. The reasons behind these rankings fall into three themes: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family. The results demonstrate that involving both patients and caregivers when determining the outcomes that should be reported in research could support a patient-centred evidence base. This may subsequently support shared decision-making and improve outcomes for individuals living with glomerular disease.

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