Abstract
This article describes two patient advisory councils (PACs) in Canada in order to contribute to the limited evidence base on how they might facilitate patient engagement in health research. Specifically, members of PACs from Newfoundland and Labrador and Alberta describe their councils’ governance structure, primary functions, creation and composition, and recount specific research-related activities with which they have been involved. Key challenges of these councils and facilitators of their use are also presented. Finally, members from both councils recount lessons learned and offer suggestions for others interested in advisory councils as a mechanism for patient engagement in any health research project. Members believe patient engagement can result in better quality research and encourage decision makers and researchers to utilize patients’ valuable input to inform health system changes and drive priorities at a policy level.
Keywords
Introduction
The value of engaging with patients to improve health-care design and delivery is well-documented (1
–3). Indeed, health-care organizations regularly consult with patient and family advisory councils (PFACs) about a variety of quality improvement and patient-centered care efforts (1,3). Reports suggest 38% to 55% of acute care hospitals in the United States have PFACs (4,5). In Canada, PFACs are convened at the family practice level (6) and at the regional and provincial health authority levels (3,7). Councils can be
Within health-care settings, PFACs advise on patient-centered care practices and contribute to quality improvement initiatives such as signage redesign in hospitals (1,3). Other role of PFACs is to facilitate patient engagement in health
Engagement can impact all stages of the research process and help to identify measures and outcomes that matter to patients, increase study recruitment rates, facilitate patient and physician co-learning about health research, and increase the uptake of study results (11 –13). In short, patient engagement can result in better quality research (1). In this paper, we focus on the use of patient advisory councils (PACs) as a mechanism for patient engagement in research. While these councils have long been established in health-care settings, their use in health research is less well described.
Setting the Stage for Our PACs in Health Research
Following international initiatives (8,14), the Canadian Institutes of Health Research (CIHR) announced Canada’s Strategy for Patient-Oriented Research (SPOR) in 2011. Its vision is that “patients are active partners in health research that will lead to improved health outcomes and an enhanced health care system (CIHR 2014) (15).” Strategy for Patient-Oriented Research included the creation of Support for People and Patient-Oriented Research and Trials (SUPPORT) Units across the country whose mandate is to facilitate patient-engaged research on local priorities. Most of these SUPPORT Units have created PACs.
A growing body of literature describes frameworks of patient engagement (16 –18), key attributes, best practices, and guiding principles (15,19,20). However, there is virtually no literature describing what PAC members actually do, nor on how PACs are used to further patient engagement in health research.
In this paper, we describe 2 PACs from Western and Eastern Canada, explaining their governance structure, primary functions, creation and composition, and specific activities undertaken by members (eg, review research funding applications and serve as project co-investigators).
It is important to highlight that PAC members from each provincial SUPPORT Unit are authors of this paper and provided their perspectives in tabular format. In the tables, members describe the activities with which they have been involved and report key challenges, facilitators, and lessons learned. All council members from both Units contributed to the lead patient authors’ drafts and gave final approval for the article. Additionally, Alberta used data from the annual PAC evaluation conducted in March 2019 to supplement the perspectives in Tables 1 and 2 with consensus from all members. The tables in this paper represent a truly collaborative effort of over 40 advisory council members from 2 provinces in Canada.
Council Member Perspectives on the NL Support Unit PACs’ Role, Member Activities, Challenges, and Facilitators.
Abbreviations: PAC, patient advisory council; POR, patient-oriented research.
Alberta Support Unit Council Member Perspectives on the PAC’s Role, Member Activities, Challenges, and Facilitators.
Abbreviations: PAC, patient advisory council; POR, patient-oriented research.
Description of Provincial Councils
Patient Advisory Council, Newfoundland and Labrador SPOR Support Unit (NL SUPPORT)
The PAC was established in 2015, comprised of 13 members from across NL. The original call for members was placed in regional community newspapers, allowing reach in remote communities. This is particularly important in NL, where over 40% of the population lives in rural settings outside the capital city of St. John’s.
Council members provide a broad patient perspective that informs the priorities and strategic direction of the Unit. In NL, the PAC is situated within a governance structure that includes several large programs of health research. Thus, council members not only are active members of NL SUPPORT but also sit on Steering Committees and Scientific Advisory Committees of the larger research programs. They suggest agenda items, lead discussion on these items, and vote on key decisions; as such, they participate fully in committee meetings. Members are also coinvestigators on research projects. The range of activities undertaken by the PAC as a whole and by individual members is presented in Table 1.
Due to increasing demands on the PAC, a second advert was run in February 2016. While membership increased, it remained largely retired and well educated. Patient advisory council members suggested that the Unit undertake a targeted recruitment campaign utilizing social media in 2017 for younger representatives. This led to a more representative advisory council of 21 members including individuals from minority groups (e.g., disabled individuals). For members of the public who are unable to commit to the workload of council members, the Unit maintains a wider advisory “Friends Pool” with whom correspondence is over e-mail. This group is comprised of 15 individuals currently, and they are consulted about specific tasks as needed (eg, to review study instruments).
Members who attend PAC meetings and/or contribute to other Unit-related activities such as committees and working groups are offered an honorarium each year. NL SUPPORT was the first SUPPORT unit across Canada to implement patient appreciation guidelines, developed fully in collaboration with PAC members in order to demonstrate the value of their contributions.
The current council meets twice a year in the capital city of St. John’s, supplemented with teleconferences and e-mail correspondence. Terms of reference were developed with the original council in 2015 and these are reviewed annually. There has been a low level of turnover in PAC members. A wide range of perspectives is self-identified on the current PAC including lived or caregiver experience with disorders such as cancer, arthritis, diabetes, heart disease, among others. Men are underrepresented (n = 4); most members have high levels of education.
Patient Advisory Council, Patient Engagement Platform, Alberta SPOR SUPPORT Unit
The idea of a PAC was conceptualized in late 2014 to have equal numbers of patients and researchers or organization members. The council was established by the Patient Engagement Platform (Platform), Alberta SPOR SUPPORT Unit in 2015. During the first year, 12 members were recruited by word-of-mouth from across AB (rural, remote, and urban) and from different research institutions and patient organizations. By 2016, members from other organizations and geographic regions were recruited; the council is currently comprised of 26 members (9 males). Members identify as having lived experiences with health conditions, whether as a patient themselves, caregiver, friend, or family member, or as a health researcher.
Council members provide strategic advice to guide Platform activities. Their role is to (a) provide input and feedback on Platform activities and deliverables, (b) assist with development of Platform activities and services, (c) inform exchanges with stakeholders (people with an interest in patient engagement in health research in AB), (d) identify relevant stakeholders to consult and engage with, and (e) be ambassadors for patient engagement within respective communities/networks. Table 2 outlines specific activities reported by patient and researcher council members in AB.
Terms of reference, reviewed annually, were codeveloped in alignment with the primary aim and role of the council. Members are invited to commit to a 3-year term. The council meets in-person quarterly with the option for teleconference and communicates via e-mail between meetings. Members are reimbursed for travel, accommodation, and registration fees associated with the events they attend. Appreciation (e.g. honorarium) is offered to members invited to copresent at events or contribute to activities such as committee work; some members accept these fees and others do not.
There has been a low turnover rate of members; 3 members left close to the end of their term. Although there are various research projects underway, committee work, or document reviews, opportunities do not always appeal to all members. Sometimes, particular individuals are sought out for opportunities for which they are best suited after an open call to the council. Many members do wish to continue past their membership term. The Unit is currently determining how to negotiate extensions so there is some overlap of existing members who have knowledge and experience to share with new members.
Discussion
Similarities and Differences Between the PACs
While the Scientific Lead and Patient Engagement Lead in NL are health researchers and faculty members who regularly attend PAC meetings, NL SUPPORT’s PAC is formally comprised of entirely patient partners. This differs from AB, where researchers and individuals from relevant organizations are council members. Both models are seen in the literature (eg, 1, 13). AB’s model formally provides space for co-learning and interaction between patients and researchers and links to local organizations and the larger AB patient engagement platform and SUPPORT Unit. The Patient Engagement Lead in AB is the cochair of the council, and staff members from the AB Platform coordinate, attend, and support the function and operations of the council.
NL’s model provides a fully patient-comprised council. While NL SUPPORT Unit staff help coordinate and support the meetings and activities of the PAC, council members rotate as meeting chair. There is no patient engagement “platform” in NL; rather, the PAC is situated within the larger governance structure of provincial research programs (eg, Choosing Wisely NL). This structure is the mechanism by which other stakeholders such as researchers, clinicians, and policy makers regularly interact with the PAC.
Councils also differ in ongoing recruitment methods for members. In AB, initially, recruitment was driven by word-of-mouth, while NL used newspaper advertising in local papers and then targeted adverts for specific demographics. AB is working toward an electronic communication platform that allows interaction between patients and researchers and serves as a tool to recruit new council members. Ultimately, a mix of recruitment strategies is observed and necessary for the ongoing recruitment of patients (21).
Members from both PACs described a wide range of involvement, spanning all stages of the health research process (Tables 1 and 2). Both PACs codeveloped terms of reference and appreciation policies and advise on the strategic direction of their respective Support Units. These PACs serve as examples of meaningful and active patient engagement in health research.
Both councils describe similar challenges, including recruiting a diversity of voices, ensuring full attendance at in-person meetings, providing meaningful engagement, and training opportunities for council members, as well as the resources needed for council creation and maintenance (Tables 1 and 2). Some strategies that work to mitigate challenges include effective communication with SUPPORT Unit staff, notions of coproduction, transparency, respect for each other’s views and lived experiences, and ongoing support for competency building (Tables 1 and 2).
Conclusions and Lessons Learned
We described 2 Canadian PACs to contribute to the evidence base on how these structures facilitate patient engagement in health research. Members depicted their contribution to numerous health research activities that spanned the health research process from priority setting to knowledge translation (11,12). In both provinces, their impact on research is visible in the sheer volume of research activities with which members are involved. To date, however, there is no systematic process for the evaluation of PAC members’ research activities. While SUPPORT units in Canada are evaluated annually by external evaluation companies, a specific focus on the evaluation of the impact of PAC members’ research activities would be a valuable area for future research.
Table 3 outlines lessons learned and recommendations as suggested by members of both councils. Respect for diverse viewpoints, varied and ongoing opportunities for engagement and training, clearly defined roles and activities, but also a flexible approach that respects members’ personal lives and interests are all key ingredients for a successful PAC. Ways to revitalize membership on both councils strategically and meaningfully requires further exploration. Our work corresponds well with emerging frameworks and best practices for patient engagement (17,18,20). By describing our experiences with PACs, we aspire to encourage their use as a facilitator of patient engagement that will help others to better integrate and utilize patients’ valuable input to inform health system changes and drive policy priorities.
Lessons Learned and Recommendations for Others on the Use of PACs in Health Research.
Abbreviation: PAC, patient advisory council.
Footnotes
Authors’ Note
Ethics review was not required for this feature article; all patient advisory council members provided consent to be listed in the acknowledgements section.
Acknowledgments
The authors would like to thank the other council members of NL SUPPORT and AbSPORU for their contributions to the Tables and final approval of the article. Specifically, at NL SUPPORT Unit, the authors thank Tina Belbin, Patti Bryant, Cris Carter, Joan Cranston, Everard (Bud) Davidge, Susan Goold, Jamie Green, Brian Johnston, David Lane, Rosemary Lester, Mandy Penney, Dorothy Senior, Mary Sparkes, Kimberley Street, Kristen Pittman, Rachel Valenti, and Emily Wadden. From AbSPORU, they thank council members: Bailey Sousa, Israel Amirav, Jane Ross, Jean Smith, Jessica Havens, John Scharrer, Katharina Kovacs Burns, Katie Birnie, Kinza Rizvi, Lauren Hebert, Melita Avdagovska, Olga Petrovskaya, Terry Kirkland, and Yesmine Elloumi. They are also grateful to NL SUPPORT staff for ongoing support to the PAC including Dale Humphries, Chelsey McPhee, Kathleen Mather, Kate Hogan, and Jessica Hickey.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
