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The Evidence Speaks

The Evidence Speaks (September 2018)

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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.
In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Song MJ, Ward J, Choi F, Nikoo M, Frank A, Shams F, Tabi K, Vigo D, Krausz MA process evaluation of a web-based mental health portal (WalkAlong) Using Google AnalyticsJMIR Ment Health. 2018 Aug 20;5(3):e50.

Dr. Michael Krausz, a CHÉOS Scientist, Leadership Chair of Addiction Research, and professor in the Department of Psychiatry, has embraced the potential of web-based interventions to treat mental illness by developing WalkAlong, a youth-oriented mental health web-portal with tools and resources to help youth manage their mental health. Unfortunately, high rates of attrition in web-based tools detract from the proven efficacy of such interventions, as is the case for inverventions targeting mental illness. Dr. Krausz and the WalkAlong team conducted a process evaluation to identify ways to improve uptake and engagement for WalkAlong in order to achieve optimal effectiveness. Through their evaluation they tested the utility of Google Analytics, an open tool providing free quantitative data on website usage, to monitor user activity and assess metrics of engagement with the web-portal. This study was the first time Google Analytics has been used to evaluate a web-based mental health intervention. A number of indicators were selected to measure website engagement including pages visited per session, utilization rate of specific features, and user access mode and location. Data were collected from the first year following the website’s launch, which included data from 3076 users viewing 29,299 pages. The average user viewed 5 and half pages in a session, with an average session lasting just over 5 minutes, however 65 percent of visits resulted in disengagement within the first minute. Roughly 43 percent of users viewed only 1 page, and most visits were only to the home page. Just less than 32 per cent of all users created an account, an indicator of more meaningful engagement. They found that users who received personal invitations to visit the site had higher engagement and feature utilization rates and that users spent more time on the mental health Screener tool compared to other self-help tools available on the site. One area of growth uncovered by the evaluation was among mobile phone users as most users accessed the platform from a desktop computer. The data provided by Google Analytics served as a starting point for identifying areas that can be improved further, but the data on its own may lend itself to multiple contradictory interpretations. The researchers suggested that supplementing Google Analytics data with other evaluation methods, or using it as part of a mixed methods assessment, could provide better guidance on modifications to improve user engagement.

Goldfarb M, Lauck S, Webb JG, Asgar AW, Perrault LP, et al. Malnutrition and mortality in older adults undergoing aortic valve replacement. Circulation. 2018 Jul 13 epub ahead of print.

Malnutrition is known to be associated with worse surgical outcomes and is a risk factor for the development of frailty. Older adults undergoing aortic valve replacement are at increased risk of malnutrition. However, research on the effect of pre-procedural malnutrition on the outcomes of aortic valve replacement is scarce. CHÉOS Scientist Dr. Sandra Lauck and an international team of researchers set out to determine how prevalent malnutrition is in older adults undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) and whether an association exists between pre-procedural nutritional status and short and medium-term morbidity and mortality following valve replacement. They used data from the FRAILTY-AVR prospective multi-center cohort study. FRAILTY-AVR was conducted between the years of 2012-2017 at sites across Canada, the United States, and France and compared frailty assessment tools and the ability to predict complications or death after cardiac surgery and transcatheter procedures. Participants were assessed on frailty and geriatric domains prior to their procedure and followed for a year afterwards. Nutritional status was assessed with the Mini Nutritional Assessment – Short Form (MNA-SF), a tool measuring six domains to detect malnutrition. Based on their MNA-SF scores patients were categorized as having normal nutritional status, at-risk of malnutrition, or having malnutrition. Two tools were used to assess frailty, the Short Physical Performance Battery (SPPB) and the Fried frailty scale. Other risk factors, such as age, sex, comorbidities, and cardiac status, were captured using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM). The study included 1,158 patients aged 70 years and older who had either undergone TAVR or SAVR. Over half the cohort were males, with a mean age of 81.3 years. The majority of patients had normal nutritional status, while roughly 33% were at risk for malnutrition and less than 10% were classified as malnourished. Those who were malnourished were found to be older, more likely to be female, and more likely to undergo TAVR and have a prior stroke or other chronic conditions. Among the TAVR group there were 126 deaths and 30 among the SAVR group. Using regression analyses, pre-procedural nutritional status was found to predict 1-year mortality and 30-day mortality and morbidity. Nutritional status was only found to be moderately correlated with frailty. The study demonstrated that screening for malnutrition can be done easily and may be of benefit if preoperative nutritional support can be provided to improve postoperative outcomes, though research is needed to test whether such interventions are possible.

Leese J, Macdonald G, Kerr S, Gulka L, Hoens AM, Lum W, Tran BC, Townsend AF, Li LC. “Adding another spinning plate to an already busy life.” Benefits and risks in patient partner-research relationships: A qualitative study of patient partners’ experiences in Canadian health research setting. BMJ Open. 2018 Aug 17;8(8):e022154.

Engagement of patient partners has been increasingly invoked as a means to making research more relevant and more likely to bring about improved health outcomes and services. When engagement is not done well it risks becoming a superficial show at inclusion and an ineffective process. CHÉOS Scientist Dr. Linda Li and Research Associate Alison Hoens were part of a qualitative study of patient partners about the risks and benefits in patient partner-research relationships. A relational ethics lens was applied in the study to draw attention to the relationship between patient partners and researchers when they engage. The study was initiated, co-designed, and co-conducted by patient partners who are members of Arthritis Research Canada’s (ARC) Arthritis Patient Advisory Board and researchers and trainees at ARC. Participants of the study were past and present members of the Advisory Board that had experience building patient partner-research relationships, including with some of the study’s coauthors. Of the 22 eligible participants interviewed, 21 of them were female and over half had completed at least 1 university degree. Transcripts of the interviews were coded by three doctoral students using a coding scheme they developed through reviewing the transcripts. Codes were clustered into thematic categories that were verified and modified in discussions with co-authors and study participants. Once thematic categories were finalized they were considered through relational ethic lens. Three main themes were identified from the interviews. The first theme was that of being heard—demonstrations of mutual respect and having contributions considered equally important by researchers mitigated participants’ feeling of insecurity or discomfort. Second, participants valued the social relationships built with researchers outside the expected interactions in the research setting. Finally, participants expressed that they appreciated researchers’ efforts to minimize the strain of research involvement to make it more manageable on top of other obligations, priorities, and their health. This study stands out as one of very few that examine patient engagement from the patient’s perspective. It benefitted from perspectives of patient partners with a range of experience of engagement: participant involvement ranged from 1 month to 10 years. Though there are limits to the transferability of the study’s findings, they may still be useful in guiding future relationship building in patient partner research and support ethically sound practice of patient engagement in health research.