Adapting two American Decision Aids for Mild Traumatic Brain Injury to the Canadian Context Using the Nominal Group Technique

El Kebir Ghandour (), Lania Lelaidier Hould, Félix-Antoine Fortier, Veronique Gélinas, Edward R. Melnick, Erik P. Hess, Eddy S. Lang, Jocelyn Gravel, Jeffrey J. Perry, Natalie Le Sage, Catherine Truchon, Annie LeBlanc, Alexander Sasha Dubrovsky, Marie-Pierre Gagnon, Marie-Christine Ouellet, Isabelle Gagnon, Suzanne McKenna, France Légaré, Louise Sauvé, Tom H. van de Belt, Éric Kavanagh, Laurence Paquette, Anne-Catherine Verrette, Patrick Plante, Richard J. Riopelle and Patrick M. Archambault
Additional contact information
El Kebir Ghandour: Institut National d’excellence en Santé et en Services Sociaux (INESSS)
Lania Lelaidier Hould: Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches
Félix-Antoine Fortier: Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches
Veronique Gélinas: Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches
Edward R. Melnick: Yale University
Erik P. Hess: University of Alabama at Birmingham
Eddy S. Lang: University of Calgary
Jocelyn Gravel: Université de Montréal
Jeffrey J. Perry: University of Ottawa
Natalie Le Sage: Université Laval
Catherine Truchon: Institut National d’excellence en Santé et en Services Sociaux (INESSS)
Annie LeBlanc: Université Laval
Alexander Sasha Dubrovsky: McGill University
Marie-Pierre Gagnon: Université Laval
Marie-Christine Ouellet: Université Laval
Isabelle Gagnon: McGill University
Suzanne McKenna: Brain Injury Canada
France Légaré: Université Laval
Louise Sauvé: TELUQ
Tom H. van de Belt: Radboud University Medical Centre
Éric Kavanagh: Université Laval
Laurence Paquette: Université Laval
Anne-Catherine Verrette: Université Laval
Patrick Plante: TELUQ
Richard J. Riopelle: McGill University
Patrick M. Archambault: Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches

The Patient: Patient-Centered Outcomes Research, 2020, vol. 13, issue 6, No 10, 729-743

Abstract: Abstract Background Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans. Objective The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head CT use for adult and paediatric mild traumatic brain injury to the Canadian context. Methods We invited 21 Canadian stakeholders and the two authors of the American decision aids to a Nominal Group Technique consensus meeting to generate suggestions for adapting the decision aids. This method encourages idea generation and sharing between team members. Each idea was discussed and then prioritised using a voting system. We collected data using videotaping, writing material and online collaborative writing tools. The modifications proposed were analysed using a qualitative thematic content analysis. Results Twenty-one participants took part in the meeting, including researchers and clinician researchers (n = 9; 43%), patient partners (n = 3; 14%) and decision makers (n = 2; 10%). A total of 84 ideas were generated. Participants highlighted the need to clarify the purpose of the decision aids, the nature of the problem being addressed and the target population. The tools require sociocultural adaptations, better identification of their target population, better description of head CT utility, advantages and related risks, modification of the visual and written representation of the risk of brain injury and head CT use, and locally adapted, patient follow-up plans. Conclusions This study based on a Nominal Group Technique identified several adaptations for two American decision aids about head CT use for mild traumatic brain injury to support their use in Canada’s different healthcare, social, cultural and legal context. These adaptations concerned the target users of the decision aids, the information presented, and how the benefits and risks were communicated in the decision aids. Future steps include prototyping the two adapted decision aids, conducting formative evaluations with actual emergency department patients and clinicians, and measuring the impact of the adapted tools on CT scan use.

Date: 2020
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DOI: 10.1007/s40271-020-00459-y

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