Stakeholder engagement analysis - a bioethics dilemma in patient-targeted intervention: patients with temporomandibular joint disorders

Abstract

Modern health care in the field of Medicine, Dentistry and Nursing is grounded in fundamental philosophy and epistemology of translational science. Recently in the U.S major national initiatives have been implemented in the hope of closing the gaps that sometimes exist between the two fundamental components of translational science, the translational research and translational effectiveness. Subsequent to these initiatives, many improvements have been made; however, important bioethical issues and limitations do still exist that need to be addressed. One such issue is the stakeholder engagement and its assessment and validation. Federal, state and local organizations such as PCORI and AHRQ concur that the key to a better understanding of the relationship between translational research and translational effectiveness is the assessment of the extent to which stakeholders are actively engaged in the translational process of healthcare. The stakeholder engagement analysis identifies who the stakeholders are, maps their contribution and involvement, evaluates their priorities and opinions, and accesses their current knowledge base. This analysis however requires conceptualization and validation from the bioethics standpoint. Here, we examine the bioethical dilemma of stakeholder engagement analysis in the context of the person-environment fit (PE-fit) theoretical model. This model is an approach to quantifying stakeholder engagement analysis for the design of patient-targeted interventions. In our previous studies of Alzheimer patients, we have developed, validated and used a simple instrument based on the PE-fit model that can be adapted and utilized in a much less studied pathology as a clinical model that has a wide range of symptoms and manifestations, the temporomandibular joint disorders (TMD). The temporomandibular joint (TMJ) is the jaw joint endowed with sensory and motor innervations that project from within the central nervous system and its dysfunction can be manifested systemically in forms of movement disorders, and related pathological symptomatologies.Currently, there is limited reliable evidence available to fully understand the complexity of the various domains of translational effectiveness, particularly in the context of stakeholder engagement and its assessment, validation as well as the bioethical implications as they pertain to evidence-based, effectivness-focused and patient-centered care.

Figure 1

Stakeholder matrix. The figure shows a simplified stakeholder matrix to exemplify the process of stakeholder “mapping”. As shown in the example provided in the figure, each stakeholder is identified as primary, key, secondary or allied. The stakeholder’s influence, role activity, and other characteristics are tabulated in the matrix, as well as the stakeholder’s effect and outcome of the healthcare intervention process. In the example provided, we have a “friend”, who could be a secondary stakeholder identified in this case as a key stakeholder, presumably because of possessing a Power of Attorney or directive who makes healthcare decisions on behalf of the patient. We observe the influence of this friend to be, at this present moment, relatively minor as visits are relatively rare. Yet, we recognize beneficial outcomes from those visits (it could also be the case that visits have a seriously detrimental outcome on the patient). This tabulation is prepared for every stakeholder, and is regularly revisited and updated.