Objective: As health technology assessment (HTA) organizations in Canada and around the world seek to involve the public and patients in their activities, frameworks to guide decisions about whom to involve, through which mechanisms, and at what stages of the HTA process have been lacking. The aim of this study was to describe the development and outputs of a comprehensive framework for involving the public and patients in a government agency's HTA process. Methods: The framework was informed by a synthesis of international practice and published literature, a dialogue with local, national and international stakeholders, and the deliberations of a government agency's public engagement subcommittee in Ontario, Canada. Results: The practice and literature synthesis failed to identify a single, optimal approach to involving the public and patients in HTA. Choice of methods should be considered in the context of each HTA stage, goals for incorporating societal and/or patient perspectives into the process, and relevant societal and/or patient values at stake. The resulting framework is structured around four actionable elements: (i) guiding principles and goals for public and patient involvement (PPI) in HTA, (ii) the establishment of a common language to support PPI efforts, (iii) a flexible array of PPI approaches, and (iv) on-going evaluation of PPI to inform adjustments over time. Conclusions: A public and patient involvement framework has been developed for implementation in a government agency's HTA process. Core elements of this framework may apply to other organizations responsible for HTA and health system quality improvement.

In Canada where long-term care is primarily oriented to elderly persons and affordable accessible housing is limited, younger disabled adults may be living in circumstances that do not meet their health needs and contribute to their social exclusion. The purpose of this study was to undertake an ethical analysis of what constitute an 'adequate' home environment for adults with significant mobility disabilities. An integrated design was used that combined qualitative interviews with normative ethical analysis in an iterative process. Twenty interviews with 19 participants were conducted in Ontario, Canada with two groups: younger adults (ages 18-55) with mobility disabilities and 'decision-makers' who consisted of policy makers, program administrators and discharge planners. Data were analyzed using a critical disability ethics approach and processes of reflective equilibrium. Drawing on Nora Jacobson's (Jacobson, 2009) taxonomy of dignity and pluralistic approaches to social justice, the concept of 'social dignity' provides a lens for exploring the adequacy of home environments for disabled people. Analyses suggested seven threshold conditions necessary for a dignity-enabling home: the ability to form and sustain meaningful relationships; access to community and civic life; access to control and flexibility of daily activities; access to opportunities for self-expression and identity affirmation; access to respectful relationships with attendants; access to opportunities to participate in school, work or leisure; access to physical, psychological and ontological security. The results have implications for housing, health and social care policies, and political reform. Social dignity provides a normative ethical grounding for assessing the adequacy of home environments. The threshold elements outline specific dignity-enabling conditions that are open to further specification or elaboration in different contexts.

Facteurs de prévision des dépenses pour les soins à domicile et les décès à domicile chez les patients atteints du cancer dans le cadre d'un programme pilote de soins palliatifs complets à domicile

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