Adapting the James Lind Alliance priority setting process to better support patient participation: an example from cystic fibrosis

Abstract

Plain english summary: Cystic fibrosis (CF) is the commonest life-limiting inherited disorder in the UK. It affects many parts of the body including the lungs and gut leading to increased infection and problems digesting food. People with CF need to undergo many treatments each day throughout their whole lives. These include tablets, inhalers and breathing exercises, which are a huge burden, taking up several hours every dayIt is therefore, really important that the treatments we give are supported by good evidence, usually gathered from clinical trials. Unfortunately, we do not have good evidence for many of the CF treatments. We recently ran an exercise known as a James Lind Alliance Priority Setting Partnership (JLA PSP) to find out which the CF community feel are the top priority research questions. People with CF and those who look after them suggested questions to be answered by clinical trials. Through a series of online surveys and workshops these were then shortlisted to give a final top ten.Due to infection risk people with CF are advised not to mix, this meant we had to do things differently to the usual way JLA PSPs are carried out. We used videoconferencing to enable multiple people with CF to participate. Surveys were accessible online and promoted through social media.

Abstract: Background The James Lind Alliance (JLA) method is well recognised for setting research priorities. The JLA approach involves a combination of surveys and workshop interactions between patients, carers and health care professionals to identify and agree on a "top ten" list of research questions. Respiratory infection is one of the hallmarks of cystic fibrosis (CF). To avoid cross infection, patients are advised not to meet face to face, preventing us following standard JLA methodology. Here we describe adaptations made during our recent JLA Priority Setting Partnership (PSP) in CF. Methods We elicited and prioritised research questions, using sequential online surveys, promoted through social media. People with CF participated in steering committee meetings and the final workshop, using videoconferencing. Alterations to workshop methodology enabled participants attending in person and those joining remotely, to contribute equally. We also altered the JLA methodology to include "lone" questions, asked by only one survey respondent. We are now working with the CF community to co-produce research projects that answer these top ten. Results There were 482 respondents, from 23 countries, who submitted 1080 questions. Increases in the number of responses occurred just after promotion on social media. Use of videoconferencing enabled participation of multiple people with CF and ensured participation from anywhere in the world, including hospital inpatients. Inclusion of lone questions resulted in one being included in our top ten. Conclusions There is no "one-size-fits-all" for patient involvement methodologies. Through altering the JLA methods to fit our patient group we achieved wide participation. We believe that methods used in our project may also be applied to future partnerships to increase participation, especially where people may be hospitalised or be unable to travel. The methodology we are developing through the JLA PSP CF2 project may be useful for other PSPs to follow.

Keywords: Cross infection; Cystic fibrosis; James Lind Alliance; Patient involvement; Priority setting partnership; Social media; Videoconferencing.

Fig. 1

Standard JLA methodology and adaptions made in the CF PSP. Standard JLA methodology is shown on the left hand side, adaptions for the CF PSP shown on the right hand side

Fig. 2

Elicitation survey. This screen shot shows how research questions were collected. A free text box was used for people to leave their answer in a narrative or story as well as by simple question format

Fig. 3

Remote participation during the final workshop. a Photograph showing room set up for videoconferencing via the BlueJeans^TM platform. b Example of electronic question list. This was made in PowerPoint and sharable to each screen. Each question could be moved as it was discussed with participants. c Quotes from feedback from remote participants

Fig. 4

Twitter analytics for the @QuestionCF account during the course of the priority setting partnership. Impressions are the total number of views of a conversation and engagements are the number of interactions people have with our content

Fig. 5

Breakdown of how many individual questions fed into the final top 10 questions. Each individual face represents one person submitting a question, pink represents people with CF and their family and friends, green represents health care professionals