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Frost J, Hall A, Taylor E, Lines S, Mandizha J, Pope C. How do patients and other members of the public engage with the orphan drug development? A narrative qualitative synthesis. Orphanet J Rare Dis 2023; 18:84. [PMID: 37069597 PMCID: PMC10108537 DOI: 10.1186/s13023-023-02682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The diversity of patient experiences of orphan drug development has until recently been overlooked, with the existing literature reporting the experience of some patients and not others. The current evidence base (the best available current research) is dominated by quantitative surveys and patient reported outcome measures defined by researchers. Where research that uses qualitative methods of data collection and analysis has been conducted, patient experiences have been studied using content analysis and automatic textual analysis, rather than in-depth qualitative analytical methods. Systematic reviews of patient engagement in orphan drug development have also excluded qualitative studies. The aim of this paper is to review qualitative literature about how patients and other members of the public engage with orphan drug development. METHODS We conducted a systematic search of qualitative papers describing a range of patient engagement practices and experiences were identified and screened. Included papers were appraised using a validated tool (CASP), supplemented by reporting guidance (COREQ), by two independent researchers. RESULTS 262 papers were identified. Thirteen papers reported a range of methods of qualitative data collection. Many conflated patient and public involvement and engagement (PPIE) with qualitative research. Patients were typically recruited via their physician or patient organisations. We identified an absence of overarching philosophical or methodological frameworks, limited details of informed consent processes, and an absence of recognisable methods of data analysis. Our narrative synthesis suggests that patients and caregivers need to be involved in all aspects of trial design, including the selection of clinical endpoints that capture a wider range of outcomes, the identification of means to widen access to trial participation, the development of patient facing materials to optimise their decision making, and patients included in the dissemination of trial results. CONCLUSIONS This narrative qualitative synthesis identified the explicit need for methodological rigour in research with patients with rare diseases (e.g. appropriate and innovative use of qualitative methods or PPIE, rather than their conflation); strenuous efforts to capture the perspectives of under-served, under-researched or seldom listened to communities with experience of rare diseases (e.g. creative recruitment and wider adoption of post-colonial practices); and a re-alignment of the research agenda (e.g. the use of co-design to enable patients to set the agenda, rather than respond to what they are being offered).
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Affiliation(s)
- Julia Frost
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK.
| | - Abi Hall
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Emily Taylor
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Sarah Lines
- South West Peninsular ILD Service, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Jessica Mandizha
- South West Peninsular ILD Service, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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A comprehensive qualitative framework for health-related quality of life in Duchenne muscular dystrophy. Qual Life Res 2023; 32:225-236. [PMID: 36050623 PMCID: PMC9829595 DOI: 10.1007/s11136-022-03240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Duchenne muscular dystrophy (DMD) is a rare x-linked neuromuscular condition predominantly affecting boys and men. There is a paucity of research qualitatively detailing the lived experience of health-related quality of life (HRQoL) for people with DMD. The aim of this study was to identify a comprehensive framework for better understanding HRQoL in DMD. METHODS Eighteen boys and men (aged 7 to ≥ 40 years) with DMD were recruited from charity Duchenne UK, a DMD support group, and 5 UK National Health Service Trusts. Semi-structured interviews were conducted using a topic guide informed by a review into HRQoL in DMD. Generic, preference-based, patient-reported outcome measures (PROs) were used as prompts. Interviews were audio recorded, transcribed verbatim and analysed using framework analysis. RESULTS Thirty-seven themes were coded, within seven categories. Six categories were conceptualised as components of HRQoL (autonomy, daily activities, feelings and emotions, identity, physical aspects, social relationships) and one considered an input (healthcare, support, and environment). Three additional themes were used to code feedback on the generic PROs (CHU-9D, EQ-5D, HUI). Social relationships received most coverage in the data and was noted as an omission from the PROs. CONCLUSION A 30-item framework for HRQoL in DMD has been developed, which was used as input into a new condition-specific HRQoL PRO and preference-based measure: the DMD-QoL. The data has value in its own right in highlighting the lived experience of HRQoL for people with DMD and as a barometer for assessing the content of HRQoL PROs for use in DMD.
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Crossnohere NL, Armstrong N, Fischer R, Bridges JFP. Diagnostic experiences of Duchenne families and their preferences for newborn screening: A mixed-methods study. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:169-177. [PMID: 35943031 PMCID: PMC9804254 DOI: 10.1002/ajmg.c.31992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
Duchenne muscular dystrophy is the most common form of muscular dystrophy diagnosed in childhood but is not routinely screened for prenatally or at birth in the United States. We sought to characterize the diagnostic experiences of families and describe their preferences for newborn screening (NBS). We conducted a registry-based survey of families with Duchenne and Becker muscular dystrophy that included open- and closed-ended questions regarding the journey to a diagnosis, preferences for when to learn of a diagnosis, and how knowledge of a diagnosis would impact life decisions. Open-ended responses were analyzed thematically, and closed-ended responses were analyzed descriptively. Sixty-five families completed the survey. The average ages of first concern and diagnosis were 2 and 4 years, respectively. One-third of families (30%) indicated that they would prefer to receive a diagnosis in the newborn period irrespective of treatment options available, and nearly all of the remaining families (93%) indicated that they would want to learn about a diagnosis if there were treatments that worked well during the newborn period. All families (100%) indicated that a diagnosis in the newborn period would impact life decisions. We identified three overarching themes, which described the stages of the diagnostic journey, including having concerns about the child, seeking answers, and receiving the diagnosis. NBS can facilitate improved health outcomes through early access to care, and inform families on major health and nonhealth decisions. The preferences and experiences of families and other stakeholders should be considered when determining the potential value and benefit of expanding NBS programs.
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Affiliation(s)
- Norah L. Crossnohere
- Department of Biomedical InformaticsThe Ohio State University College of MedicineColumbusOhioUSA,Present address:
Department of Internal MedicineDivision of General Internal Medicine, The Ohio State University College of MedicineColumbusOhioUSA
| | - Niki Armstrong
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA
| | - Ryan Fischer
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA
| | - John F. P. Bridges
- Department of Biomedical InformaticsThe Ohio State University College of MedicineColumbusOhioUSA
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The Cure SMA Clinical Trial Experience Survey: A Study of Trial Participant Perspectives on Clinical Trial Management and Patient-Centric Management Practices. Neurol Ther 2022; 11:1167-1181. [PMID: 35635603 PMCID: PMC9149668 DOI: 10.1007/s40120-022-00360-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Understanding clinical trial experiences can illuminate opportunities to optimize trial design and management, with potential benefits for recruitment and retention. This study sought to better understand clinical trial participant experiences and attitudes within spinal muscular atrophy (SMA), and how the evolving treatment landscape and participant characteristics may predict attitudes. Methods A survey was developed following a review of published literature and discussions with caregivers of SMA trial participants. This was distributed via email to known trial participants in Cure SMA’s database, announcements in Cure SMA’s newsletter, and emails to SMA clinical trial principal investigators. Results Seventy complete surveys reflecting unique clinical trial experiences were included in analysis. Responses revealed positive attitudes about clinical trial management overall. Top motivators for trial participation included clinical benefit, investigational drug access, and the opportunity to help others. Top concerns were safety, whether benefits would justify risks, and concerns about pain accompanying tests. The greatest stressors were fear of pain, adverse event concerns, and challenges managing medical complications of SMA. Top benefits of trial participation were hope for a better future, helping others, and relationships with the study team. In regression analysis, participant gender, age, and race all emerged as significant predictors (p < 0.05) of motivators, concerns, stressors, and benefits, as did respondent type, knowledge about SMA, distance to the trial site, and treatment era. Top recommendations for improving study management all related to receiving more information. Conclusion This research provides new perspective on patient experiences in SMA clinical trials. It underscores the importance of information and efforts to anticipate and accommodate participant needs. These findings may inform study design and interactions with research participants. They may become especially important in supporting recruitment and retention as more treatment options become available. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00360-w. Clinical trials can be stressful experiences for patients and their caregivers, especially when participants are affected by serious diseases. By understanding trial participants’ attitudes and experiences, researchers may be better able to accommodate their interests when designing and conducting research studies. This study sought insight into attitudes and experiences of spinal muscular atrophy (SMA) clinical trial participants by surveying people who participated in SMA clinical trials in the USA. The data used in analysis reflected 70 unique clinical trial experiences. Survey responses revealed positive attitudes about clinical trial management overall. Top motivators for trial participation included clinical benefit, investigational drug access, and the opportunity to help others. Top concerns were safety, whether benefits would justify risks, and concerns about pain accompanying tests. The greatest stressors were fear of pain, adverse event concerns, and challenges managing medical complications of SMA. Top benefits of trial participation were hope for a better future, helping others, and relationships with the study team. Whether or not specific motivators, concerns, stressors, and benefits were important was predicted by participant gender, age, and race, as well as respondent type (participant or caregiver), knowledge about SMA, distance to the trial site, and treatment era. Top recommendations for improving study management all related to receiving more information. This research provides new perspective on patient experiences in SMA clinical trials, and may be used to inform future study design and interactions with research participants.
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Francisco R, Brasil S, Pascoal C, Jaeken J, Liddle M, Videira PA, Dos Reis Ferreira V. The road to successful people-centric research in rare diseases: the web-based case study of the Immunology and Congenital Disorders of Glycosylation questionnaire (ImmunoCDGQ). Orphanet J Rare Dis 2022; 17:134. [PMID: 35331276 PMCID: PMC8944152 DOI: 10.1186/s13023-022-02286-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Background Congenital Disorders of Glycosylation (CDG) are a complex family of rare metabolic diseases. Robust clinical data collection faces many hurdles, preventing full CDG biological and clinical comprehension. Web-based platforms offer privileged opportunities for biomedical data gathering, and participant recruitment, particularly in rare diseases. The immunology and CDG electronic (e-) questionnaire (ImmunoCDGQ) explores this paradigm, proposing a people-centric framework to advance health research and participant empowerment. Objective The objectives of this study were to: (1) Describe and characterize the ImmunoCDGQ development, engagement, recruitment, participation, and result dissemination strategies; (2) To critically compare this framework with published literature and making recommendations. Methods An international, multistakeholder people-centric approach was initiated to develop and distribute the ImmunoCDGQ, a multi-lingual e-questionnaire able to collect immune-related data directly from patients and family caregivers. An adapted version was produced and distributed among the general “healthy” population (ImmunoHealthyQ), serving as the control group. Literature screening was performed to identify and analyze comparable studies. Results The ImmunoCDGQ attained high participation and inclusion rates (94.6%, 209 out of 221). Comparatively to the control, CDG participants also showed higher and more variable questionnaire completion times as well as increased English version representativeness. Additionally, 20% of the CDG group (42 out of 209) chose not to complete the entire questionnaire in one go. Conditional logic structuring guided participant data provision and accurate data analysis assignment. Multi-channel recruitment created sustained engagement with Facebook emerging as the most followed social media outlet. Still, most included ImmunoCDGQ questionnaires (50.7%, 106 out of 209) were submitted within the first month of the project’s launch. Literature search and analysis showed that most e-questionnaire-based studies in rare diseases are author-built (56.8%, 25 out of 44), simultaneously addressing medical and health-related quality of life (HRQoL) and/or information needs (79.5%, 35 out of 44). Also, over 68% of the studies adopt multi-platform recruitment (30 out of 44) actively supported by patient organizations (52.3%, 23 out of 44). Conclusions The ImmunoCDGQ, its methodology and the CDG Community served as models for health research, hence paving a successful and reproducible road to people-centricity in biomedical research. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02286-w.
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Affiliation(s)
- Rita Francisco
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Sandra Brasil
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Carlota Pascoal
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Jaak Jaeken
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Center for Metabolic Diseases, Department of Pediatrics, KU Leuven, 3000, Leuven, Belgium
| | - Merell Liddle
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Paula A Videira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal
| | - Vanessa Dos Reis Ferreira
- CDG & Allies-Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal. .,Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516, Caparica, Portugal.
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Chow AJ, Iverson R, Lamoureux M, Tingley K, Jordan I, Pallone N, Smith M, Al-Baldawi Z, Chakraborty P, Brehaut J, Chan A, Cohen E, Dyack S, Gillis LJ, Goobie S, Graham ID, Greenberg CR, Grimshaw JM, Hayeems RZ, Jain-Ghai S, Jolly A, Khangura S, MacKenzie JJ, Major N, Mitchell JJ, Nicholls SG, Pender A, Potter M, Prasad C, Prosser LA, Schulze A, Siriwardena K, Sparkes R, Speechley K, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, van Karnebeek C, Walia JS, Wilson BJ, Wilson K, Potter BK. Families' healthcare experiences for children with inherited metabolic diseases: protocol for a mixed methods cohort study. BMJ Open 2022; 12:e055664. [PMID: 35193919 PMCID: PMC8867352 DOI: 10.1136/bmjopen-2021-055664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Children with inherited metabolic diseases (IMDs) often have complex and intensive healthcare needs and their families face challenges in receiving high-quality, family centred health services. Improvement in care requires complex interventions involving multiple components and stakeholders, customised to specific care contexts. This study aims to comprehensively understand the healthcare experiences of children with IMDs and their families across Canada. METHODS AND ANALYSIS A two-stage explanatory sequential mixed methods design will be used. Stage 1: quantitative data on healthcare networks and encounter experiences will be collected from 100 parent/guardians through a care map, 2 baseline questionnaires and 17 weekly diaries over 5-7 months. Care networks will be analysed using social network analysis. Relationships between demographic or clinical variables and ratings of healthcare experiences across a range of family centred care dimensions will be analysed using generalised linear regression. Other quantitative data related to family experiences and healthcare experiences will be summarised descriptively. Ongoing analysis of quantitative data and purposive, maximum variation sampling will inform sample selection for stage 2: a subset of stage 1 participants will participate in one-on-one videoconference interviews to elaborate on the quantitative data regarding care networks and healthcare experiences. Interview data will be analysed thematically. Qualitative and quantitative data will be merged during analysis to arrive at an enhanced understanding of care experiences. Quantitative and qualitative data will be combined and presented narratively using a weaving approach (jointly on a theme-by-theme basis) and visually in a side-by-side joint display. ETHICS AND DISSEMINATION The study protocol and procedures were approved by the Children's Hospital of Eastern Ontario's Research Ethics Board, the University of Ottawa Research Ethics Board and the research ethics boards of each participating study centre. Findings will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Andrea J Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Iverson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Pallone
- Patient Partner, Canadian PKU & Allied Disorders Inc, Toronto, Ontario, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| | - Zobaida Al-Baldawi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alicia Chan
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Dyack
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Jane Gillis
- Department of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Sharan Goobie
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cheryl R Greenberg
- Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Jolly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Contagion Consulting Group, Ottawa, Ontario, Canada
| | - Sara Khangura
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer J MacKenzie
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - John J Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andreas Schulze
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Sparkes
- Departments of Medical Genetics and Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kathy Speechley
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Sylvia Stockler
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mari Teitelbaum
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yannis Trakadis
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Clara van Karnebeek
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Jagdeep S Walia
- Medical Genetics, Department of Pediatrics, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Brenda J Wilson
- Faculty of Medicine Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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LoRusso S, Eichinger K, Higgs K, Lewis L, Walker M, Albert J, Langer M, Tawil R, Statland JM, Kimminau KS. A Roadmap to Patient Engagement: Facioscapulohumeral Muscular Dystrophy and the ReSolve Clinical Trial. Neurol Clin Pract 2021; 11:e722-e726. [PMID: 34840889 PMCID: PMC8610524 DOI: 10.1212/cpj.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022]
Abstract
We describe our efforts to overcome barriers to patient engagement in facioscapulohumeral muscular dystrophy (FSHD) and offer a roadmap that can be replicated in other rare neurologic disorders. We implemented an engagement plan during Clinical Trial Readiness to Solve Barriers to Drug Development for FSHD (ReSolve), an 18-month, multisite, observational study of individuals with FSHD. Elements of our engagement plan included conducting focus groups during protocol development, patient involvement on the ReSolve external advisory committee, creation of a patient advisory committee, and collaboration with patient advocacy groups. Patient feedback led to adaptations in the study protocol and to changes in recruitment and retention methods. Patient engagement ensures that the patient voice contributes to multiple aspects of trial design and implementation. Our engagement efforts exemplify how collaboration with patients and families can be accomplished in FSHD and the resultant roadmap process may be replicable in other rare neurologic diseases.
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Affiliation(s)
- Samantha LoRusso
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Katy Eichinger
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Kiley Higgs
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Leann Lewis
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Michaela Walker
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - James Albert
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Michele Langer
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Rabi Tawil
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Jeffrey M Statland
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Kim S Kimminau
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
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8
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Mathews KD, Conway KM, Gedlinske AM, Johnson N, Street N, Butterfield RJ, Hung M, Ciafaloni E, Romitti PA. Characteristics of Clinical Trial Participants with Duchenne Muscular Dystrophy: Data from the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STAR net). CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100835. [PMID: 34682100 PMCID: PMC8534386 DOI: 10.3390/children8100835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Therapeutic trials are critical to improving outcomes for individuals diagnosed with Duchenne muscular dystrophy (DMD). Understanding predictors of clinical trial participation could maximize enrollment. METHODS Data from six sites (Colorado, Iowa, Piedmont region North Carolina, South Carolina, Utah, and western New York) of the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) were analyzed. Clinical trial participation and individual-level clinical and sociodemographic characteristics were obtained from medical records for the 2000-2015 calendar years. County-level characteristics were determined from linkage of the most recent county of residence identified from medical records and publicly available federal datasets. Fisher's exact and Wilcoxon two-sample tests were used with statistical significance set at one-sided p-value (<0.05) based on the hypothesis that nonparticipants had fewer resources. RESULTS Clinical trial participation was identified among 17.9% (MD STARnet site: 3.7-27.3%) of 358 individuals with DMD. Corticosteroids, tadalafil, and ataluren (PTC124) were the most common trial medications recorded. Fewer non-Hispanic blacks or Hispanics than non-Hispanic whites participated in clinical trials. Trial participants tended to reside in counties with lower percentages of non-Hispanic blacks. Conclusion: Understanding characteristics associated with clinical trial participation is critical for identifying participation barriers and generalizability of trial results. MD STARnet is uniquely able to track clinical trial participation through surveillance and describe patterns of participation.
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Affiliation(s)
| | - Kristin M. Conway
- Department of Epidemiology, The University of Iowa, Iowa City, IA 52242, USA;
| | - Amber M. Gedlinske
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242, USA;
| | - Nicholas Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Natalie Street
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30329, USA;
| | - Russell J. Butterfield
- Departments of Pediatrics and Neurology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA;
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester, Rochester, NY 14642, USA;
| | - Paul A. Romitti
- Department of Epidemiology, The University of Iowa, Iowa City, IA 52242, USA;
- Correspondence: ; Tel.: +1-(319)-335-4912
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9
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Trost JP, Chen M, Stark MM, Hodges JS, Richter S, Lindsay A, Warren GL, Lowe DA, Kimberley TJ. Voluntary and magnetically evoked muscle contraction protocol in males with Duchenne muscular dystrophy: Safety, feasibility, reliability, and validity. Muscle Nerve 2021; 64:190-198. [PMID: 33974714 DOI: 10.1002/mus.27323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION/AIMS Clinical trials addressing treatments for Duchenne muscular dystrophy (DMD) require reliable and valid measurement of muscle contractile function across all disease severity levels. In this work we aimed to evaluate a protocol combining voluntary and evoked contractions to measure strength and excitability of wrist extensor muscles for safety, feasibility, reliability, and discriminant validity between males with DMD and controls. METHODS Wrist extensor muscle strength and excitability were assessed in males with DMD (N = 10; mean ± standard deviation: 15.4 ± 5.9 years of age), using the Brooke Upper Extremity Rating Scale (scored 1-6), and age-matched healthy male controls (N = 15; 15.5 ± 5.0 years of age). Torque and electromyographic (EMG) measurements were analyzed under maximum voluntary and stimulated conditions at two visits. RESULTS A protocol of multiple maximal voluntary contractions (MVCs) and evoked twitch contractions was feasible and safe, with 96% of the participants completing the protocol and having a less than 7% strength decrement on either measure for both DMD patients and controls (P ≥ .074). Reliability was excellent for voluntary and evoked measurements of torque and EMG (intraclass correlation coefficient [ICC] over 0.90 and over 0.85 within and between visits, respectively). Torque, EMG, and timing of twitch-onset measurements discriminated between DMD and controls (P < .001). Twitch contraction time did not differ significantly between groups (P = .10). DISCUSSION Findings from this study show that the protocol is a safe, feasible, reliable, and a valid method to measure strength and excitability of wrist extensors in males with DMD.
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Affiliation(s)
- Joyceann P Trost
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mo Chen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Molly M Stark
- Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Richter
- Professional Data Analysts, Minneapolis, Minnesota, USA
| | - Angus Lindsay
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA
| | - Dawn A Lowe
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Teresa J Kimberley
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,School of Health and Rehabilitation Sciences, Department of Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
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10
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Tingley K, Coyle D, Graham ID, Chakraborty P, Wilson K, Potter BK. Stakeholder perspectives on clinical research related to therapies for rare diseases: therapeutic misconception and the value of research. Orphanet J Rare Dis 2021; 16:26. [PMID: 33436030 PMCID: PMC7805116 DOI: 10.1186/s13023-020-01624-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background For many rare diseases, few treatments are supported by strong evidence. Patients, family members, health care providers, and policy-makers thus have to consider whether to accept, recommend, or fund treatments with uncertain clinical effectiveness. They must also consider whether and how to contribute to clinical research that may involve receiving or providing the therapy being evaluated. Objective To understand why and how patients and families with rare metabolic diseases, specialist metabolic physicians, and health policy advisors choose whether to participate in studies and how they use and value research. Methods We conducted separate focus group interviews with each stakeholder group (three groups in total); two groups were conducted by telephone and the third was held in-person. Participants were recruited using purposive sampling. We analyzed each interview transcript sequentially using a qualitative description approach to inductively identify key themes. Several strategies to ensure credibility and trustworthiness were used including debriefing sessions after each focus group and having multiple team members review transcripts. Results Four patients/caregivers, six physicians, and three policy advisors participated. Our findings did not support conventional perspectives that therapeutic misconception (gaining access to treatment) is the main motivating factor for patients/caregivers to participate in clinical research. Rather, patients’/caregivers’ expressed reasons for participating in research included advancing science for the next generation and having an opportunity to share their experiences. Patients/caregivers and physicians described the difficulties in weighing risks versus benefits of accepting treatments not well-supported by evidence. Physicians also reported feeling conflicted in their dual role as patient advisor/advocate and evaluator of the evidence. Policy advisors were primarily focused on critically appraising the evidence to make recommendations for the health system. Conclusions Stakeholders differ in their perspectives on rare disease research but share concerns about the risks versus benefits of therapies when making individual- and population-level decisions.
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Affiliation(s)
- Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Pranesh Chakraborty
- Metabolics and Newborn Screening, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,Newborn Screening Ontario, Ottawa, ON, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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11
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Choong Wong S, Joseph S, Capaldi N, Marco MD, Dunne J, Guglieri M, Horrocks I, Straub V, Faisal Ahmed S. A survey of the feasibility of developing osteoporosis clinical trials in Duchenne muscular dystrophy: Survey of the opinion of young people with Duchenne muscular dystrophy, families and clinicians. Clin Trials 2020; 18:39-50. [PMID: 33012180 DOI: 10.1177/1740774520958395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Given the extent of osteoporosis in people with Duchenne muscular dystrophy treated with glucocorticoids and the limited evidence of bone-protective therapies, clinical trials are needed. We conducted surveys to obtain the opinion of young people with Duchenne muscular dystrophy, parents/guardians and neuromuscular clinicians on the feasibility of osteoporosis clinical trials in this population. METHODS Online surveys were sent to three groups: (a) people with a confirmed diagnosis of Duchenne muscular dystrophy (≥14 years), (b) parents and guardians and (c) neuromuscular clinicians in the UK NorthStar Clinical Network. Surveys (a) and (b) were distributed via the UK Duchenne muscular dystrophy Registry. RESULTS Survey respondents included 52 people with Duchenne muscular dystrophy with a median age of 17 years (range: 14, 40) and 183 parents/guardians. Fourteen out of 23 (61%) NorthStar centres responded. Of the 52 people with Duchenne muscular dystrophy, 13 (25%) were very concerned about their bone health and 21 (40%) were slightly concerned. Of the 183 parents/guardians, 75 (41%) were very concerned about their son's bone health and 90 (49%) were slightly concerned. Fractures and quality of life were the top two main outcome measures identified by people with Duchenne muscular dystrophy. Fractures and bone density were the top two main outcome measures identified by parents/guardians and neuromuscular clinicians. Thirty percent of people with Duchenne muscular dystrophy and 40% of parents/guardians would not take part if an osteoporosis trial involved a placebo that was administered parenterally. Only 2 of the 14 NorthStar centres (14%) would enrol people with Duchenne muscular dystrophy if a parenteral placebo was used in an osteoporosis trial in Duchenne muscular dystrophy. CONCLUSION There is great awareness of bone health and the need for bone-protective trials among people with Duchenne muscular dystrophy and their carers. However, a proportion of people with Duchenne muscular dystrophy and parents are reluctant to participate in a placebo-controlled osteoporosis trial that included a parenteral therapy. A larger proportion of health care experts are unwilling to enrol their patients in such a trial. Our finding is relevant for the design of bone-protective studies in Duchenne muscular dystrophy.
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Affiliation(s)
- Sze Choong Wong
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Shuko Joseph
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK.,Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Nadia Capaldi
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Marina Di Marco
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,Scottish Muscle Network, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jennifer Dunne
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Iain Horrocks
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
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12
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Price D, Edwards M, Carson-Stevens A, Cooper A, Davies F, Evans B, Hibbert P, Hughes T, Rainer T, Siriwardena N, Edwards A. Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers' experiences. BMC Med Res Methodol 2020; 20:151. [PMID: 32522265 PMCID: PMC7288546 DOI: 10.1186/s12874-020-01039-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/01/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We report from one study which aimed to collect evidence on patients' experiences of attending emergency departments with different models of using general practitioners, but faced challenges in recruiting patients. This paper aims to identify and reflect on the challenges faced at all stages of patient recruitment, from identifying and inviting eligible patients, consenting them for participation and finally to engaging them in interviews, and make recommendations based on our learning. METHODS A thematic analysis was carried out on field-notes taken during research visits and meeting minutes of discussions to review and improve patient recruitment throughout the study. RESULTS The following factors influenced the success of patient recruitment in the emergency department setting: complicated or time-consuming electronic health record systems for identifying patients; narrow participant eligibility criteria; limited research nurse support; and lack of face-to-face communication between researchers and eligible patients. CONCLUSIONS This paper adds to the methodological evidence for improving patient recruitment in different settings, with a focus on qualitative research in emergency departments. Our findings have implications for future studies attempting to recruit patients in similar settings.
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Affiliation(s)
- Delyth Price
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales.
| | - Michelle Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Andrew Carson-Stevens
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Alison Cooper
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Freya Davies
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Bridie Evans
- Swansea University Medical School, Swansea University, Swansea, Wales
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Thomas Hughes
- Emergency Department, John Radcliffe Hospital, Oxford, England
| | - Tim Rainer
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Niro Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
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13
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Health-related quality of life scores of typically developing children and adolescents around the world: a meta-analysis with meta-regression. Qual Life Res 2020; 29:2311-2332. [DOI: 10.1007/s11136-020-02519-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
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14
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Adams HR, Defendorf S, Vierhile A, Mink JW, Marshall FJ, Augustine EF. A novel, hybrid, single- and multi-site clinical trial design for CLN3 disease, an ultra-rare lysosomal storage disorder. Clin Trials 2019; 16:555-560. [PMID: 31184505 DOI: 10.1177/1740774519855715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Travel burden often substantially limits the ability of individuals to participate in clinical trials. Wide geographic dispersion of individuals with rare diseases poses an additional key challenge in the conduct of clinical trials for rare diseases. Novel technologies and methods can improve access to research by connecting participants in their homes and local communities to a distant research site. For clinical trials, however, understanding of factors important for transition from traditional multi-center trial models to local participation models is limited. We sought to test a novel, hybrid, single- and multi-site clinical trial design in the context of a trial for Juvenile Neuronal Ceroid Lipofuscinosis (CLN3 disease), a very rare pediatric neurodegenerative disorder. METHODS We created a "hub and spoke" model for implementing a 22-week crossover clinical trial of mycophenolate compared with placebo, with two 8-week study arms. A single central site, the "hub," conducted screening, consent, drug dispensing, and tolerability and efficacy assessments. Each participant identified a clinician to serve as a collaborating "spoke" site to perform local safety monitoring. Study participants traveled to the hub at the beginning and end of each study arm, and to their individual spoke site in the intervening weeks. RESULTS A total of 18 spoke sites were established for 19 enrolled study participants. One potential participant was unable to identify a collaborating local site and was thus unable to participate. Study start-up required a median 6.7 months (interquartile range = 4.6-9.2 months). Only 33.3% (n = 6 of 18) of spoke site investigators had prior clinical trial experience, thus close collaboration with respect to study startup, training, and oversight was an important requirement. All but one participant completed all study visits; no study visits were missed due to travel requirements. CONCLUSIONS This study represents a step toward local trial participation for patients with rare diseases. Even in the context of close oversight, local participation models may be best suited for studies of compounds with well-understood side-effect profiles, for those with straightforward modes of administration, or for studies requiring extended follow-up periods.
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Affiliation(s)
- Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara Defendorf
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Frederick J Marshall
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
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15
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Lindsay S, Cagliostro E, McAdam L. Meaningful occupations of young adults with muscular dystrophy and other neuromuscular disorders. The Canadian Journal of Occupational Therapy 2019; 86:277-288. [PMID: 31096763 DOI: 10.1177/0008417419832466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Youth with Duchenne muscular dystrophy (DMD) and other neuromuscular disorders are living well into adulthood and often need help engaging in meaningful occupations. PURPOSE. Our purpose was to explore enablers and barriers to engaging in meaningful occupations, from the perspectives of youth, parents, and practitioners. METHOD. This qualitative study involved 26 participants (11 parents, eight youth ages 19 to 28 [mean = 22.3 years], seven practitioners). Data were obtained from semistructured interviews and analyzed using an interpretive descriptive approach. FINDINGS. Youth with DMD and neuromuscular disorders engage in meaningful occupations in a variety of ways. Occupational enablers were supports and accommodations and self-care skills and coping strategies, while occupational barriers involved societal expectations of a normative adulthood, discrimination and inaccessible environments, lack of supports and resources, medical challenges, fatigue, lack of motivation, and social isolation and depression. IMPLICATIONS. Practitioners should work to uncover what youth consider important and connect them to appropriate resources so they can engage in meaningful occupations.
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16
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Sætrang T, Bjørk IT, Capjon H, Rasmussen M. Parent-child communication and timing of interventions are challenges in the Duchenne muscular dystrophy care. Acta Paediatr 2019; 108:535-540. [PMID: 30118557 DOI: 10.1111/apa.14537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 08/04/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
AIM Duchenne muscular dystrophy (DMD) is an X-linked myopathy affecting one in 3600-6000 live male births. The aim of this study was to gain further insight into how parents experience caring for boys with DMD. METHODS Using a qualitative design, parents in 12 families with boys with DMD, whereof two pairs of siblings, were interviewed in 2014 and 2015. Participants were parents of boys followed at Oslo University Hospital or other hospitals in the south-eastern health region of Norway. Mean age of the boys was 13 years, range 7-17. RESULTS Parents expressed the importance of obtaining good information about the diagnosis, supplied with sensitivity for them as clients, and the parents must be involved in timing of interventions. Meeting with others in the same situation was highly appreciated. Many of the parents expressed their own need for support to cope with the difficult situation. Continuity of support in the boys' transition to adulthood was pointed out as important, as well as the need for professional help to talk to the boys about their diagnosis. CONCLUSION Our study suggests that professional teams should expand the parental perspective and emphasise a holistic approach in their work with patients with DMD.
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Affiliation(s)
- T Sætrang
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
| | - I T Bjørk
- Department of Nursing Science University of Oslo Oslo Norway
| | - H Capjon
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
| | - M Rasmussen
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
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17
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van Beek DJ, van Leeuwaarde RS, Pieterman CRC, Vriens MR, Valk GD. 'Quality in, quality out', a stepwise approach to EBM for rare diseases promoted by MEN1. Endocr Connect 2018; 7:/journals/ec/aop/ec-18-0359.xml. [PMID: 30352412 PMCID: PMC6215791 DOI: 10.1530/ec-18-0359] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/13/2018] [Indexed: 12/20/2022]
Abstract
Rare diseases pose specific challenges in the field of medical research to provide physicians with evidence based guidelines derived from studies with sufficient quality. An example of these rare diseases is multiple endocrine neoplasia type 1 (MEN1), which is an autosomal dominant endocrine tumor syndrome with an estimated occurrence rate of 2-3 per 100.000. For this complex disease, characterized by multiple endocrine tumors, it proves difficult to perform both adequate and feasible studies. The opinion of patients themselves is of utmost importance to identify the gaps in the evidence based medicine regarding clinical care. In the search for scientific answers to clinical research questions, the aim for best available evidence is obvious. Observational studies within patient cohorts, although prone to bias, seem the most feasible study design regarding the disease prevalence. Knowledge and adaptation to all types of bias is demanded in the strive for answers. Guided by our research on MEN1 patients, we elaborate on strategies to identify sufficient patients, to maximize and maintain patient enrollment and to standardize the data collection process. Preferably, data collection is performed prospectively, however, under certain conditions data storage in a longitudinal retrospective database with a disease-specific framework is suitable. Considering the global challenges on observational research on rare diseases, we propose a stepwise approach from clinical research questions to scientific answers.
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Affiliation(s)
- Dirk-Jan van Beek
- Department of Endocrine Surgical OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Carolina R C Pieterman
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgical OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
- Parelsnoer InstituteUtrecht, The Netherlands
| | - the DutchMEN Study Group
- Department of Endocrine Surgical OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
- Parelsnoer InstituteUtrecht, The Netherlands
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18
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Peay HL, Biesecker BB, Wilfond BS, Jarecki J, Umstead KL, Escolar DM, Tibben A. Barriers and facilitators to clinical trial participation among parents of children with pediatric neuromuscular disorders. Clin Trials 2018; 15:139-148. [PMID: 29475375 DOI: 10.1177/1740774517751118] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Pediatric rare disease presents a challenging situation of high unmet need and a limited pool of potential clinical trial participants. Understanding perspectives of parents of children who have not participated in trials may facilitate approaches to optimize participation rates. The objective of this study was to explore factors associated with parental interest in enrolling children with pediatric neuromuscular disorders in clinical trials. METHODS Parents of individuals with Duchenne or Becker muscular dystrophy and spinal muscular atrophy were recruited through advocacy organizations, a registry, and clinics. These parents ( N = 203) completed a questionnaire including assessments of barriers and facilitators to clinical trial participation, parents' interest in trial participation, and their perceptions of others' views about participation in a clinical trial. RESULTS Trial interest in participating parents was high (64% combined group). The most highly endorsed barrier to participation was the possibility of receiving placebo, followed by not having enough information on risks and trial procedures. Compared to parents of children with Duchenne or Becker muscular dystrophy, parents of children with spinal muscular atrophy endorsed significantly more information and knowledge barriers. The greatest facilitators of participation were (1) confidence in improving disease understanding and (2) guarantee to receive the treatment after a successful trial. A logistic regression model, χ2 (4, n = 188) = 80.64, p < .001, indicated that higher perceived barriers and more frequent trial communication by the provider were associated with lower interest, while positive trial perceptions by the child's providers and concordance in trial perceptions among those close to the decision-maker were associated with higher interest. CONCLUSION We found high parental interest in pediatric neuromuscular trials that was tempered by concerns about the potential for randomization to a placebo arm. Participants perceived that their trial participation would be facilitated by additional education and guidance from their clinicians. Yet, intentions were negatively associated with frequency of provider communication, perhaps reflecting waning parental interest with a greater understanding of limitations in trial access, increased sophistication in their understanding of trial design, and appreciation of potential burden. To support parents' informed decisions, it is important to educate them to evaluate the quality of research, as well as providing lay information explaining the use of placebo, trial processes, and potential barriers to long-term drug access. Our findings should inform the development of targeted educational content, clinician training, and decision support tools.
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Affiliation(s)
- Holly L Peay
- 1 RTI International, Research Triangle Park, NC, USA.,2 Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Barbara B Biesecker
- 3 Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Kendall L Umstead
- 3 Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Aad Tibben
- 7 Leiden University Medical Center, Leiden, The Netherlands
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Young A, Menon D, Street J, Al-Hertani W, Stafinski T. Exploring patient and family involvement in the lifecycle of an orphan drug: a scoping review. Orphanet J Rare Dis 2017; 12:188. [PMID: 29273068 PMCID: PMC5741909 DOI: 10.1186/s13023-017-0738-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i.e., orphan drug lifecycle). METHODS A scoping review was conducted using methods outlined by Arksey and O'Malley. To validate the findings from the literature and identify any additional opportunities that were missed, a consultative webinar was conducted with members of the Patient and Caregiver Liaison Group of a Canadian research network. RESULTS Existing and proposed opportunities for involving patients, families, and patient organizations were reported throughout the orphan drug lifecycle and fell into 12 themes: research outside of clinical trials; clinical trials; patient reported outcomes measures; patient registries and biorepositories; education; advocacy and awareness; conferences and workshops; patient care and support; patient organization development; regulatory decision-making; and reimbursement decision-making. Existing opportunities were not described in sufficient detail to allow for the level of involvement to be assessed. Additionally, no information on the impact of involvement within specific opportunities was found. Based on feedback from patients and families, documentation of existing opportunities within Canada is poor. CONCLUSIONS Opportunities for patient, family, and patient organization involvement exist throughout the orphan drug lifecycle. However, based on the information found, it is not possible to determine which opportunities would be most effective at each stage.
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Affiliation(s)
- Andrea Young
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Jackie Street
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Walla Al-Hertani
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
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Amelot V, Bungener C, Guilmin-Crepon S, Schroedt J, Alberti C, Husson I. Preferences for Receiving Results from a Rare Disease Clinical Trial: A Survey of Subjects with Friedreich’s Ataxia and their Parents. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McCarthy MW, Walsh TJ. Drug development challenges and strategies to address emerging and resistant fungal pathogens. Expert Rev Anti Infect Ther 2017; 15:577-584. [PMID: 28480775 DOI: 10.1080/14787210.2017.1328279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Invasive fungal infections represent an expanding threat to public health. The recent emergence of Candida auris, which is often resistant to existing antifungal agents and is associated with a high mortality rate, underscores the urgent need for novel drug development strategies. Areas covered: In this paper, we examine both challenges and opportunities associated with antifungal drug development and explore potential avenues to accelerate the development pipeline, including data sharing, surrogate endpoints, and the role of historical controls in clinical trials. Expert commentary: We review important lessons learned from the study of other rare diseases, including mitochondrial storage diseases and certain forms of cancer that may inform strategies to develop new antifungal agents while highlighting promising new compounds such as SCY-078 for the treatment of invasive fungal infections.
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Affiliation(s)
- Matthew W McCarthy
- a Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA
| | - Thomas J Walsh
- b Weill Cornell Medical Center , Transplantation-Oncology Infectious Diseases Program , New York , NY , USA
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Baldo C, Casareto L, Renieri A, Merla G, Garavaglia B, Goldwurm S, Pegoraro E, Moggio M, Mora M, Politano L, Sangiorgi L, Mazzotti R, Viotti V, Meloni I, Pellico MT, Barzaghi C, Wang CM, Monaco L, Filocamo M. The alliance between genetic biobanks and patient organisations: the experience of the telethon network of genetic biobanks. Orphanet J Rare Dis 2016; 11:142. [PMID: 27776540 PMCID: PMC5078978 DOI: 10.1186/s13023-016-0527-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) are often neglected because they affect a small percentage of the population (6-8 %), which makes research and development of new therapies challenging processes. Easy access to high-quality samples and associated clinical data is therefore a key prerequisite for biomedical research. In this context, Genetic Biobanks are critical to developing basic, translational and clinical research on RDs. The Telethon Network of Genetic Biobanks (TNGB) is aware of the importance of biobanking as a service for patients and has started a dialogue with RD-Patient Organisations via promotion of dedicated meetings and round-tables, as well as by including their representatives on the TNGB Advisory Board. This has enabled the active involvement of POs in drafting biobank policies and procedures, including those concerning ethical issues. Here, we report on our experience with RD-Patient Organisations who have requested the services of existing biobanks belonging to TNGB and describe how these relationships were established, formalised and maintained. RESULTS The process of patient engagement has proven to be successful both for lay members, who increased their understanding of the complex processes of biobanking, and for professionals, who gained awareness of the needs and expectations of the people involved. This collaboration has resulted in a real interest on the part of Patient Organisations in the biobanking service, which has led to 13 written agreements designed to formalise this process. These agreements enabled the centralisation of rare genetic disease biospecimens and their related data, thus making them available to the scientific community. CONCLUSIONS The TNGB experience has proven to be an example of good practice with regard to patient engagement in biobanking and may serve as a model of collaboration between disease-oriented Biobanks and Patient Organisations. Such collaboration serves to enhance awareness and trust and to encourage the scientific community to address research on RDs.
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Affiliation(s)
- Chiara Baldo
- S.C. Laboratorio di Genetica Umana, E.O. Ospedali Galliera, Genoa, Italy
| | - Lorena Casareto
- Ufficio Coordinamento Network, c/o U.O.S.D. Centro di Diagnostica Genetica e Biochimica delle Malattie Metaboliche, Istituto G. Gaslini, Genoa, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena and Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuseppe Merla
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, FG Italy
| | - Barbara Garavaglia
- U.O.C. Neurogenetica Molecolare, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefano Goldwurm
- Parkinson Institute, ASST Centro Specialistico Ortopedico Traumatologico G. Pini – CTO, Milan, Italy
| | - Elena Pegoraro
- Università di Padova, Azienda Ospedaliera Universitaria, Padova, Italy
| | - Maurizio Moggio
- Neuromuscular and Rare Diseases Unit, Dino Ferrari Centre, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marina Mora
- Laboratorio di Biologia Cellulare, UO Malattie Neuromuscolari e Neuroimmunologia, Fond. IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Politano
- Cardiomiologia e Genetica Medica, Dipartimento di Medicina Sperimentale, Seconda Università di Napoli e Azienda Ospedaliera Universitaria della SUN, Naples, Italy
| | - Luca Sangiorgi
- S.S.D. Genetica Medica e Malattie Rare Ortopediche Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Raffaella Mazzotti
- U.O.S.D. Centro di Diagnostica Genetica e Biochimica delle Malattie Metaboliche, Istituto G. Gaslini, Via G. Gaslini 5, 16147 Genoa, Italy
| | - Valeria Viotti
- S.C. Laboratorio di Genetica Umana, E.O. Ospedali Galliera, Genoa, Italy
| | - Ilaria Meloni
- Medical Genetics, University of Siena and Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Teresa Pellico
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, FG Italy
| | - Chiara Barzaghi
- U.O.C. Neurogenetica Molecolare, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Mirella Filocamo
- U.O.S.D. Centro di Diagnostica Genetica e Biochimica delle Malattie Metaboliche, Istituto G. Gaslini, Via G. Gaslini 5, 16147 Genoa, Italy
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