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Alpert JM, Wang S, Bylund CL, Markham MJ, Bjarnadottir RI, Lee JH, Lafata JE, Salloum RG. Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE). PATIENT EDUCATION AND COUNSELING 2021; 104:1380-1386. [PMID: 33280967 DOI: 10.1016/j.pec.2020.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers. PURPOSE Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging. METHODS A 26 balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets. RESULTS 210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored. CONCLUSIONS Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies. PRACTICE IMPLICATIONS Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, USA.
| | - Shu Wang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Carma L Bylund
- Department of Public Relations, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | | | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Jennifer Elston Lafata
- UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
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2
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Ohsumi S, Mukai H, Takahashi M, Hozumi Y, Akabane H, Park Y, Tokunaga E, Takashima T, Watanabe T, Sagara Y, Kaneko T, Ohashi Y. Factors affecting enrollment in randomized controlled trials conducted for patients with metastatic breast cancer. Jpn J Clin Oncol 2020; 50:873-881. [PMID: 32463090 DOI: 10.1093/jjco/hyaa065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is critical to obtain informed consent from eligible patients to complete clinical trials. We investigated the factors that affect the participation rates of eligible patients. PATIENTS AND METHODS Patients with metastatic breast cancer who were eligible for SELECT BC or SELECT BC-CONFIRM trials, randomized controlled trials conducted for patients with chemotherapy-naive metastatic breast cancer were recruited to prospective studies, SELECT BC-FEEL and SELECT BC-FEEL II, respectively. SELECT BC FEEL and SELECT BC-FEEL II were conducted to identify the factors affecting the rates at which informed consent was obtained, using a self-administered questionnaire we developed. RESULTS In total, 232 patients participated in the studies. The patients who agreed to take part in the randomized trials were more likely than the refusers to answer that they decided to participate because: 'My doctor wanted me to participate in this trial' (P = 0.00000), ' My family or friends wanted me to participate in this trial' (P = 0.00000), 'Both treatment regimens used in the trial are suitable to me' (P = 0.00383), 'I know that the trial is conducted to determine which is a better treatment' (P = 0.01196), and ' I think that my participation in the trial will contribute to the benefit to future patients with the same disease' (P = 0.00756). CONCLUSIONS To enhance the consent rate in randomized trials of metastatic breast cancer patients, concepts of the trials must be considered important and acceptable not only by patients but also by doctors and their families.
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama 791-0280, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo
| | - Yasuo Hozumi
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Kasama
| | | | - Youngjin Park
- Department of Breast and Endocrine Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai
| | - Eriko Tokunaga
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai
| | - Yoshiaki Sagara
- Department of Breast Oncology, Hakuaikai Medical Corp Sagara Hospital, Kagoshima
| | - Tetsuji Kaneko
- Department of Clinical Research, Tokyo Metropolitan Children's Medical Center, Fuchu
| | - Yasuo Ohashi
- Faculty of Science and Engineering, Chuo University, Tokyo
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Kong QH, Yang LP, Lai YR, Qin HY, He LZ, Liu YS, Li YE, Chen XJ, Qiu MZ, Wang ZX, Wang Y. Analysis of the perceptions and attitudes to participate in radical and palliative clinical trials among Chinese lymphoma and head/neck cancer patients. J Cancer 2019; 10:3253-3258. [PMID: 31289597 PMCID: PMC6603383 DOI: 10.7150/jca.30057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/29/2019] [Indexed: 11/26/2022] Open
Abstract
Objective: The purpose of this prospective study was to investigate the perceptions and attitudes to participate in radical and palliative clinical trials among Chinese lymphoma and head/neck cancer patients. Patients and Methods: A self-developed questionnaire was administered to hospitalized patients in the Department of Medical Oncology in Sun Yat-Sen University Cancer Center between 20 September 2014 and 20 September 2015. This study included lymphoma patients who were enrolled into a radical treatment clinical trial, and head/neck cancer patients participating in a palliative clinical trial. Results: There were 136 lymphoma patients and 87 head/neck cancer patients who completed and returned the questionnaire. The questionnaire return rate was 100%. More than 90% of the patients in both groups showed trust and acceptance for medical care personnel, and more than 50% of the patients in both groups were in hope of trying new medication, receiving free medication, and receiving new treatment at an earlier rate. As compared with those in the radical trials, patients in the palliative clinical trials were more likely to hope to try new medication (P<0.001) and receive a new treatment at an earlier date (P=0.025), but less likely to hope to receive free medication (P=0.047). Conclusions: This study reveals several shared perceptions and needs of patients in both the radical (lymphoma) and palliative (head/neck cancer) settings and explores the differences in patients' attitudes between radical clinical trials and palliative clinical trials. These findings may provide a basis for improving recruitment of patients for different types of clinical trials and ensuring that patients have a better understanding of clinical trials.
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Affiliation(s)
- Qiu-Huan Kong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Lu-Ping Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yue-Rong Lai
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Gynecological Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui-Ying Qin
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nursing, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Lian-Zhu He
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Clinical Research, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yu-Shan Liu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yan-Er Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Clinical Research, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Xiu-Jin Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Clinical Research, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Miao-Zhen Qiu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zi-Xian Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Ghare MI, Chandrasekhar J, Mehran R, Ng V, Grines C, Lansky A. Sex Disparities in Cardiovascular Device Evaluations. JACC Cardiovasc Interv 2019; 12:301-308. [DOI: 10.1016/j.jcin.2018.10.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
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Bonin K, McGuffin M, Lechtman E, Cumal A, Harth T, Calabrese E, Feldman-Stewart D, Burnett J, Ellis J, Di Prospero L, Szumacher E. Evaluation of an Online Education Resource on Radiation Therapy Created for Patients with Postprostatectomy Prostate Cancer and Their Caregivers. J Med Imaging Radiat Sci 2018; 49:365-370. [PMID: 30514552 DOI: 10.1016/j.jmir.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Radiation therapy (RT) after prostatectomy is an important curative treatment option for patients with prostate cancer. It can be delivered immediately after surgery as adjuvant treatment, or after biochemical PSA failure as salvage treatment. There is currently a lack of consensus regarding whether salvage RT in the event of biochemical failure or immediate adjuvant RT is the optimal postprostatectomy RT treatment. Although both types of postprostatectomy RT are generally well tolerated, patients may develop some toxicity that can impact their quality of life and the duration and frequency of treatments can be challenging for patients. It is imperative that patients be provided with evidence-based information so that they are able to make a treatment decision most aligned with their values. METHODS To help address patients' informational needs, an online education resource was created for patients with prostate cancer considering postoperative RT. Patients and their families were asked to evaluate the effectiveness of this resource using a validated purpose-based information assessment. RESULTS Nineteen patients were approached and 14 participated, but only five patients returned their evaluations (35%). Sixty percent found the information to be important with regards to each of the six commonly identified purposes in the purpose-based information assessment: organizing, understanding, decision-making, planning, emotional support, and discussing. Only one participant found the information hard to understand and had difficulty finding specific information. DISCUSSION Patients should be encouraged to actively participate in their treatment decision-making process involving postprostatectomy RT. For patients to make well-informed decisions, patients must be provided with clear and accessible information so that they may understand their disease and the treatment options. CONCLUSION An online education resource has been developed that most study respondents found clear and helpful for a variety of identified purposes. Overall, this online education resource has the potential to reach a large number of patients and their caregivers who desire specific information and involvement in future treatment decisions.
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Affiliation(s)
- Katija Bonin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Merrylee McGuffin
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eli Lechtman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Cumal
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Harth
- Patient Education, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eirena Calabrese
- Oncology Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Julie Burnett
- Department of Patient and Family Support, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Janet Ellis
- Department of Psychiatry, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Spence O, Onwuchekwa Uba R, Shin S, Doshi P. Patient consent to publication and data sharing in industry and NIH-funded clinical trials. Trials 2018; 19:269. [PMID: 29724236 PMCID: PMC5934880 DOI: 10.1186/s13063-018-2651-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participants are recruited into clinical trials under the assumption that the research will contribute to medical knowledge. Therefore, non-publication trials-and, more recently, lack of data sharing-are widely considered to violate the trust of trial participants. Existing practices regarding patient consent to publication and data sharing have not been evaluated. Analyzing informed consent forms (ICFs), we studied what trial participants were told regarding investigators' intention to contribute to medical knowledge, publish trial results, and share de-identified trial data. METHODS We obtained 98 ICFs of industry-funded pre-marketing trials for all (17) antibiotics approved by the European Medicines Agency and 46 ICFs of publicly funded trials from the National Heart, Lung and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) data repository. Three authors independently reviewed ICFs to identify and extract what was stated or implied regarding: (1) publication of results; (2) sharing de-identified data; (3) data ownership; (4) confidentiality of identifiable data; and (5) whether the trial will produce knowledge that offers public benefit. Consensus was obtained from the two reviewers with the greatest overall agreement on all five measures. Disagreements were resolved through discussion among all authors. RESULTS Four (3%) trials indicated a commitment to publish trial results; 140 (97%) did not commit to publishing trial results; six (4%) indicated a commitment to share de-identified data with third party researchers. Commitments to share were more common in publicly funded trials than industry-funded trials (7% vs 3%). A total of 103 (72%) ICFs indicated the trials will or may produce knowledge that offers public benefits, while 131 (91%) ICFs left unstated who "owned" trial data; of those with statements, the sponsor always claimed ownership. Patient confidentiality was guaranteed in 137 (95%) trials. CONCLUSIONS Our results suggest that consent forms rarely disclose investigators' intentions regarding the sharing of de-identified data or publication of trial results.
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Affiliation(s)
- O’Mareen Spence
- University of Maryland School of Pharmacy, Baltimore, MD USA
| | | | - Seongbin Shin
- University of Maryland School of Pharmacy, Baltimore, MD USA
| | - Peter Doshi
- University of Maryland School of Pharmacy, Baltimore, MD USA
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Partridge AH, Sepucha K, O'Neill A, Miller KD, Motley C, Swaby RF, Schneider BP, Dang CT, Northfelt DW, Sledge GW. Effect of Unblinding on Participants' Perceptions of Risk and Confidence in a Large Double-Blind Clinical Trial of Chemotherapy for Breast Cancer. JAMA Oncol 2016; 1:369-74. [PMID: 26114161 DOI: 10.1001/jamaoncol.2015.0246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Blinding patients to treatment regimen is an important component of high-quality randomized clinical trials, although concern exists about how receipt of a placebo will affect participants' views, particularly among patients with cancer. OBJECTIVE To determine whether unblinding of random assignment to placebo vs experimental agent in a large adjuvant breast cancer chemotherapy randomized clinical trial was associated with perception of greater chance of cancer recurrence and lower confidence in the decision to participate in the trial in participants who were randomized to placebo compared with those randomized to experimental therapy. DESIGN, SETTING, AND PARTICIPANTS Serial telephone-based prospective survey substudy of all Eastern Cooperative Oncology Group Protocol 5103 (ECOG5103) participants enrolling between January 5 and June 8, 2010. In ECOG5103, patients were randomized to receive standard adjuvant chemotherapy for breast cancer with either placebo or bevacizumab for either approximately 6 or approximately 12 months. Treatment assignment was unblinded by 24 weeks, and then patients were surveyed. MAIN OUTCOMES AND MEASURES Trial participants' self-reported perceived risk of recurrence and confidence in study participation. RESULTS Of 571 patients in this substudy who started protocol therapy, 550 were still in the study at unblinding and 492 (89%) responded to the unblinding survey. At unblinding, 336 of 477 (70%) believed that they had at most a small risk of breast cancer recurrence, and 342 of 480 (71%) reported perceiving at most a small risk of serious problem with therapy; most reported feeling very informed (421 of 483 [87%]) and having high levels of confidence in their study participation (420 of 483 [87%]). The 102 participants who learned that they had been randomized to placebo did not have greater perception of chance of recurrence (P = .48) or fear of recurrence (P = .69), feel less informed (P = .86), or have lower confidence in trial participation (P = .31) compared with the 390 participants who had been randomized to experimental therapy. Patients who learned that they had been randomized to bevacizumab perceived higher risk of having a serious problem caused by treatment (P = .01). CONCLUSIONS AND RELEVANCE In a placebo-controlled, double-blind randomized clinical trial of chemotherapy for breast cancer, unblinding to randomization allocation did not significantly affect most participants' views except for chance of a serious problem from experimental treatment, regardless of receipt of placebo or experimental anticancer therapy along with standard chemotherapy.
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Gollhofer SM, Wiskemann J, Schmidt ME, Klassen O, Ulrich CM, Oelmann J, Hof H, Potthoff K, Steindorf K. Factors influencing participation in a randomized controlled resistance exercise intervention study in breast cancer patients during radiotherapy. BMC Cancer 2015; 15:186. [PMID: 25885634 PMCID: PMC4466838 DOI: 10.1186/s12885-015-1213-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background Over the past years knowledge about benefits of physical activity after cancer is evolving from randomized exercise intervention trials. However, it has been argued that results may be biased by selective participation. Therefore, we investigated factors influencing participation in a randomized exercise intervention trial for breast cancer patients. Methods Non-metastatic breast cancer patients were systematically screened for a randomized exercise intervention trial on cancer-related fatigue. Participants and nonparticipants were compared concerning sociodemographic characteristics (age, marital status, living status, travel time to the training facility), clinical data (body-mass-index, tumor stage, tumor size and lymph node status, comorbidities, chemotherapy), fatigue, and physical activity. Reasons for participation or declination were recorded. Results 117 patients (52 participants, 65 nonparticipants) were evaluable for analysis. Multiple regression analyses revealed significantly higher odds to decline participation among patients with longer travel time (p = 0.0012), living alone (p = 0.039), with more comorbidities (0.031), previous chemotherapy (p = 0.0066), of age ≥ 70 years (p = 0.025), or being free of fatigue (p = 0.0007). No associations were found with BMI or physical activity. By far the most frequently reported reason for declination of participation was too long commuting time to the training facility. Conclusions Willingness of breast cancer patients to participate in a randomized exercise intervention study differed by sociodemographic factors and health status. Neither current physical activity level nor BMI appeared to be selective for participation. Reduction of personal inconveniences and time effort, e.g. by decentralized training facilities or flexible training schedules, seem most promising for enhancing participation in exercise intervention trials. Trial registration Registered at ClinicalTrials.gov: NCT01468766 (October 2011).
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Affiliation(s)
- Sandra M Gollhofer
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Joachim Wiskemann
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Department of Medical Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), Divisions of Medical Oncology and Preventive Oncology, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Martina E Schmidt
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Oliver Klassen
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Cornelia M Ulrich
- Department of Preventive Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Jan Oelmann
- Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Holger Hof
- Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Karin Potthoff
- Department of Medical Oncology, National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Department of Radiation Oncology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Karen Steindorf
- Unit of Physical Activity and Cancer, Department of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. .,Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy. Support Care Cancer 2015; 23:1169-96. [PMID: 25591627 DOI: 10.1007/s00520-014-2581-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. METHODS An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. RESULTS In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. CONCLUSIONS Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.
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Tariman JD, Doorenbos A, Schepp KG, Singhal S, Berry DL. Older adults newly diagnosed with symptomatic myeloma and treatment decision making. Oncol Nurs Forum 2014; 41:411-9. [PMID: 24969250 PMCID: PMC4074776 DOI: 10.1188/14.onf.411-419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the preferences for participation in decision making of older adult patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. DESIGN Descriptive, cross-sectional design. SETTING Participants' homes and two large academic cancer centers in Seattle, WA, and Chicago, IL. SAMPLE A convenience sample of 20 older adults (60 years of age and older) with symptomatic myeloma diagnosed within the past six months. METHODS The Control Preferences Scale was administered followed by an in-person, one-time, semistructured interview. MAIN RESEARCH VARIABLES Role preferences for participation in treatment decision making, age, gender, race, work status, personal relationship status, education, and income. FINDINGS Fifty-five percent of the participants preferred a shared role with the physician and 40% preferred to make the decisions after seriously considering the opinion of their physicians. Only one participant preferred to leave the decision to the doctor, as long as the doctor considered the patient's treatment preferences. CONCLUSIONS The study findings indicate that older adults newly diagnosed with myeloma want to participate in treatment decision making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow him or her to be autonomous in making treatment decisions. IMPLICATIONS FOR NURSING Nurses and other oncology clinicians can elicit a patient's preferred level of participation in treatment decision making. Oncology nurses can make sure patients receive disease- and treatment-related information, encourage them to express their decisional role preference to the physician, develop a culture of mutual respect and value their desire for autonomy for treatment decision making, acknowledge that the right to make a treatment choice belongs to the patient, and provide support during treatment decision making throughout the care continuum.
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Affiliation(s)
- Joseph D Tariman
- Division of Hematology and Oncology, Northwestern University Medical Faculty Foundation, Chicago, IL
| | | | | | - Seema Singhal
- Multiple Myeloma Program in the Division of Hematology and Oncology, Northwestern University
| | - Donna L Berry
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA
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Ohsumi S, Mukai H, Ohashi Y. Factors Affecting Enrollment in a Randomized Controlled Trial for Japanese Metastatic Breast Cancer Patients (SELECT BC-FEEL)--A Prospective Study. Jpn J Clin Oncol 2014; 44:696-701. [DOI: 10.1093/jjco/hyu065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Habersack M, Luschin G. Insecurities of women regarding breast cancer research: a qualitative study. PLoS One 2013; 8:e81770. [PMID: 24312584 PMCID: PMC3847121 DOI: 10.1371/journal.pone.0081770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Only 1.2%–11% of all potential study participants participate in cancer studies. Low participation rates can result in bias or in a failure to obtain data saturation. Subject-scientific psychology assumes that reasons for acting are based on individual premises. The objective of this study was to render reproducible individual reasons of female breast cancer patients to participate or not participate in breast cancer studies using a qualitative approach. Methods Problem-based interviews were conducted with female breast cancer patients. The selection of interview partners continued until theoretical data saturation was achieved. Results As main arguments against participation emotional overload and too many medication side-effects were stated. Improvement of health-related values, long-term protection and comprehensive follow-up exams were stated as arguments for participation. Trust in the attending physician was mentioned as influencing both participation and non-participation. Conclusions A significant influential factor determining willingness to participate in studies was one's contentment with patient-physician communication. In order to guarantee an adequate patient decision-making process, keeping existing standards for patient briefings is absolutely mandatory.
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Affiliation(s)
- Marion Habersack
- Office of the Vice Rector for Teaching and Studies, Medical University Graz, Graz, Austria
- * E-mail:
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Mancini J, Chabannon C, Vey N, Billard-Daufresne LM, Pellegrini I, Julian-Reynier C. [Perception by cancer patients of biomedical research in the era of large-scale biobanking]. Med Sci (Paris) 2012; 28 Spec No 1:28-32. [PMID: 22494654 DOI: 10.1051/medsci/2012281s108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In French hospitals, patients are increasingly asked to participate in research, particularly in oncology where the development of research is stimulated at a national level (plan Cancer). This article express our thoughts based on the literature about the perception by cancer patients of research activities developed in the care centre where they are treated. We focus mainly on the consent for biobanking in a context in which cancer patients are routinely requested to donate tumour samples for research. This article presents the results of a survey among patients treated in a comprehensive cancer centre. The available literature shows that patients have an overall positive image of medical research and of the existence of research activities intertwined with medical care. Patients are globally expressing a wish for more proposals to participate in research in collaboration with scientific teams.
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Mancini J, Genre D, Dalenc F, Ferrero JM, Kerbrat P, Martin AL, Roché H, Maylevin F, Tarpin C, Viens P, Gamet C, Julian-Reynier C. Patients' regrets after participating in a randomized controlled trials depended on their involvement in the decision making. J Clin Epidemiol 2012; 65:635-42. [PMID: 22436109 DOI: 10.1016/j.jclinepi.2011.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 11/30/2011] [Accepted: 12/06/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the factors associated with long-term regrets expressed a posteriori by randomized controlled trial (RCT) participants questioned about their decision to participate in an RCT. STUDY DESIGN AND SETTING Participants were questioned 6 years on average after their inclusion in a breast cancer adjuvant therapy RCT. Among 115 women from 21 centers, 93 (81%) answered a self-administered questionnaire based on the Decision Regret Scale (DRS). RESULTS Mean DRS score was 16.8 (standard deviation=15.9); 43.0% of participants expressed mild regret, and 25.8% expressed moderate to strong regret. A quarter of the women (25.6%) said that the decision was taken by the doctor alone, and 13.5% said it was not consistent with their own wishes. In the multivariate ordinal regression analysis, an involuntarily passive role in decision making was found to be associated with greater regret (cumulative proportional odds ratio=7.3, 95% confidence interval=2.0-27.6), regardless of age and being allotted or not to the standard treatment in the RCT. CONCLUSION Whether patients' regret depended on their level of participation in the decision making or vice versa could not be determined in this cross-sectional survey, but efforts should be made to ensure that patients' participation in trials is always based on an active personal decision.
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Affiliation(s)
- Julien Mancini
- Aix-Marseille University, School of Medicine, Marseille F-13385, France.
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Luschin G, Habersack M, Gerlich IA. Reasons for and against participation in studies of medicinal therapies for women with breast cancer: a debate. BMC Med Res Methodol 2012; 12:25. [PMID: 22405127 PMCID: PMC3329416 DOI: 10.1186/1471-2288-12-25] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A special challenge for research studies of breast cancer among females is low patient participation rates. We compiled this systematic review to identify reasons why women with, or at high risk of, breast cancer do or do not participate in medicinal studies of breast cancer. METHOD A systematic literature search in the databases Cochrane Library, EMBASE, Medline, Pascal Biomed, ACP Journal Club and CINAHL, as well as searches through reference lists of relevant texts, was performed. RESULTS Of 39 relevant full texts, ultimately, nine studies (1 qualitative, 8 quantitative) were included after applying the inclusion criteria. Despite a lack of data material, it was possible to identify various factors influencing women's willingness to participate in medicinal studies and group them into three categories: person-related, study-related, and physician-related. CONCLUSION Reasons for or against participation in studies of medicinal therapies by women with, or at high risk of, breast cancer are multi-dimensional, and should be considered when planning such studies to garner higher participation rates. For a more comprehensive picture of factors that affect participation, further studies in this field are recommended.
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Affiliation(s)
- Gero Luschin
- Medical University Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
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Yang ZJ, McComas KA, Gay GK, Leonard JP, Dannenberg AJ, Dillon H. Comparing decision making between cancer patients and the general population: thoughts, emotions, or social influence? JOURNAL OF HEALTH COMMUNICATION 2012; 17:477-94. [PMID: 22376222 DOI: 10.1080/10810730.2011.635774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study extends a risk information seeking and processing model to explore the relative effect of cognitive processing strategies, positive and negative emotions, and normative beliefs on individuals' decision making about potential health risks. Most previous research based on this theoretical framework has examined environmental risks. Applying this risk communication model to study health decision making presents an opportunity to explore theoretical boundaries of the model, while also bringing this research to bear on a pressing medical issue: low enrollment in clinical trials. Comparative analysis of data gathered from 2 telephone surveys of a representative national sample (n = 500) and a random sample of cancer patients (n = 411) indicated that emotions played a more substantive role in cancer patients' decisions to enroll in a potential trial, whereas cognitive processing strategies and normative beliefs had greater influences on the decisions of respondents from the national sample.
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Affiliation(s)
- Z Janet Yang
- Department of Communication, State University of New York at Buffalo, Buffalo, New York 14260, USA.
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The attitudes of oncology physicians and nurses toward phase I, II, and III cancer clinical trials. Contemp Clin Trials 2011; 32:649-53. [PMID: 21570486 DOI: 10.1016/j.cct.2011.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 04/20/2011] [Accepted: 04/29/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to assess the attitudes of oncology physicians and nurses toward phase I, II, and III cancer clinical trials. METHODS A questionnaire was administered to 358 oncology physicians and nurses. RESULTS The effective response rate was 79.3%. Of the respondents, 67.6%, 95.1%, and 98.6% reported that cancer patients would benefit from phase I, II, and III trials, respectively. Respondents would also recommend that their patients participate in phase I (64.4%), II (88.4%), and III trials (95.1%). When asked to assume the role of cancer patients, the respondents themselves were willing to participate in phase I (48.2%), II (72.9%), and III trials (89.8%). Respondents who admitted having little or no understanding of cancer clinical trials were not willing to recommend participation in phase I clinical trials to their patients (OR 0.187, 95% CI 0.110-0.319, p<0.001). No factor was significantly associated with respondents' willingness to recommend that their patients participate in phase II or III clinical trials. CONCLUSION Most physicians and nurses hold positive attitudes toward clinical trials, especially phases II and III. The number of medical staff who approved of clinical trials was positively associated with the stage of the phase trial.
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Atkinson NL, Massett HA, Mylks C, McCormack LA, Kish-Doto J, Hesse BW, Wang MQ. Assessing the impact of user-centered research on a clinical trial eHealth tool via counterbalanced research design. J Am Med Inform Assoc 2011; 18:24-31. [PMID: 21169619 DOI: 10.1136/jamia.2010.006122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Informatics applications have the potential to improve participation in clinical trials, but their design must be based on user-centered research. This research used a fully counterbalanced experimental design to investigate the effect of changes made to the original version of a website, http://BreastCancerTrials.org/, and confirm that the revised version addressed and reinforced patients' needs and expectations. DESIGN Participants included women who had received a breast cancer diagnosis within the last 5 years (N=77). They were randomized into two groups: one group used and reviewed the original version first followed by the redesigned version, and the other group used and reviewed them in reverse order. MEASUREMENTS The study used both quantitative and qualitative measures. During use, participants' click paths and general reactions were observed. After use, participants were asked to answer survey items and open-ended questions to indicate their reactions and which version they preferred and met their needs and expectations better. RESULTS Overall, the revised version of the site was preferred and perceived to be clearer, easier to navigate, more trustworthy and credible, and more private and safe overall. However, users who viewed the original version last had similar attitudes toward both versions. CONCLUSION By applying research findings to the redesign of a website for clinical trial searching, it was possible to re-engineer the interface to better support patients' decisions to participate in clinical trials. The mechanisms of action in this case appeared to revolve around creating an environment that supported a sense of personal control and decisional autonomy.
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Affiliation(s)
- Nancy L Atkinson
- Department of Public and Community Health, University of Maryland, College Park, Maryland 20742, USA.
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Li JY, Yu CH, Jiang Y. Participation in Cancer Clinical Trials as Viewed by Chinese Patients and Their Families. Oncology 2010; 79:343-8. [DOI: 10.1159/000323325] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
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Venetis MK, Robinson JD, Turkiewicz KL, Allen M. An evidence base for patient-centered cancer care: a meta-analysis of studies of observed communication between cancer specialists and their patients. PATIENT EDUCATION AND COUNSELING 2009; 77:379-383. [PMID: 19836920 DOI: 10.1016/j.pec.2009.09.015] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 03/31/2009] [Accepted: 09/11/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE In the context of patients visiting cancer specialists, the objective is to test the association between both patient-centered communication (including Affective Behavior and Participation Behavior) and Instrumental Behavior and patients' post-visit satisfaction with a variety of visit phenomena. METHODS Meta-analysis of 25 articles representing 10 distinct data sets. RESULTS Both patient-centered- and instrumental behavior are significantly, positively associated with satisfaction, with patient-centered communication having a relatively stronger association. CONCLUSION There is an evidence base for the efficacy of patient-centered care. PRACTICE IMPLICATIONS Cancer specialists need to train to improve their patient-centered communication.
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Affiliation(s)
- Maria K Venetis
- Department of Communication, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA.
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