Next Steps Toward Improving the Quality, Relevance, and Implementation of Chronic Limb-Threatening Ischemia Research Through Stakeholder Engagement

Abstract

Stakeholder-engaged research (SER), in which patients and other stakeholders (including academics) engage as research, has been shown to improve the quality, feasibility, relevance, and implementation of research. There is scant SER in vascular surgery. Attitudes toward SER have not been assessed among academic vascular surgery stakeholders (clinicians and clinical researchers). Therefore, it is unclear how to increase SER to improve the care and outcomes of patients with vascular disease. As part of a Patient-Centered Outcomes Research Institute grant to increase stakeholder-centricity and sustainable engagement in chronic limb-threatening ischemia (CLTI) research, we developed an anonymous online survey based off qualitative interviews with 10 academic stakeholders. Survey responses are presented descriptively, grouped by prior SER experience. There were 42 responses to the survey for analysis. Of these, 19 had prior SER experience and 23 did not. A total of 89% of experienced respondents (ER) were moderately or extremely familiar with the term SER vs 35% of inexperienced respondents (IR). In general, ER and IR agreed about the benefits of SER, including improved relevance of research questions (80% ER, 79% IR) and selection of more relevant outcome measures (67% and 63%, respectively; Table I). However, ER more commonly reported that SER was the ethically/morally correct thing to do (60% vs 32%). There were noticeable differences in experienced/perceived drawbacks to SER, particularly in relation to the research design process (reported to be slower by 77% of ER vs 36% of IR) and the scientific interest of SER (reported to be less interesting by 8% of ER vs 29% of IR; Table I). Respondents agreed that lack of awareness was the largest barrier to increasing CLTI-related SER. However, IR identified some additional significant barriers (Table II). ER thought stakeholder training materials would be the most helpful resource to increase CLTI-related SER (73% vs 50%), whereas IR preferred assistance identifying and coordinating stakeholders (55% vs 71%; Table II). ER were more likely to feel that it was very or extremely important to partner with stakeholders in future research design/conduct (72% vs 22%). Researchers experienced with engaging stakeholders balanced a belief in its benefits with a realistic understanding of its associated difficulties. Some inexperienced researchers were strongly interested in future SER but highlighted several barriers to entry. Future efforts to increase SER in CLTI should focus on raising awareness of its benefits and the process, while lowering barriers to entry and assisting experienced researchers with well-defined pain points.Table IExperienced and perceived benefits and drawbacks to stakeholder-engaged research (SER)SER-experienced respondentsSER-inexperienced respondentsBenefits associated with SERN = 15N = 19 More relevant questions8079 More relevant outcomes6763 More ethical6032 Researcher-patient relationships5347 More relevant intervention5358 Follow-up feasibility4737 Recruitment and retention4047 Researcher satisfaction3316 Easier implementation2026 Easier funding1321 Easier publication75Drawbacks associated with SERN = 13N = 14 Slower design7736 Slower conduct4636 More expensive2336 Harder to get funding1521 Less interesting829 Harder to publish814 Less meaningful80 Less satisfying00Data are presented as percentage. Open table in a new tab Table IIBarriers and facilitators to stakeholder-engaged research (SER)SER-experienced respondentsSER-inexperienced respondentsBarriers to SER Awareness6967 Methodologic expertise3840 Interest3833 Access to stakeholders3153 Stakeholder knowledge3153 Stakeholder selection criteria2340 Stakeholder health status2327 Lack of dissemination opportunities150 Lack of regulatory mandate1520 Lack of funding820 Logistical difficulties820Potential facilitators for SER Stakeholder training materials7350 Stakeholder identification and coordination5571 Methodology collaborations4536 Funding aggregation2764 Methodologic training materials2736 Aggregation of regulatory guidance2714 Aggregation of dissemination opportunities914Data are presented as percentage. Open table in a new tab