Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines

Abstract

Introduction Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. Methods We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. Results We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. Conclusions This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. Patient or public contribution This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

“…20 Doing all that is possible to improve the stressful experiences of cumulative social deprivation such as deficits in educational opportunities, health care access, racial discrimination, race-based implicit biases and others, do appear to contribute to a high degree in terms of unsatisfactory orthopedic-related outcomes observed for some minority groups and others, especially the socio economically disadvantaged groups and its members and warrant dedicated attention. 40,[67][68][69] In this regard, three points offered by observations of Abuwa et al, 70…”

Do clinical guidelines support person-centred care for women affected by dementia: A content analysis

“…This study found that many guidelines lacked person-centred care content, and even when mentioned, details were brief, providing little assistance to clinicians who have advocated for greater guidance ( Bourque & Foley, 2020 ; Koch et al, 2010 ; Mansfield et al, 2019 ) given lack of training in person-centred care ( Anderson & Gagliardi, 2021a ; 2021b ). This raises the question of why included dementia guidelines, and guidelines on other topics did not address person-centred care for women ( Abuwa et al, 2023 ; Gagliardi et al, 2019 ). Notably, few guidelines included in this study involved women living with dementia or caregivers in their development.…”