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Weiss EM, Porter KM, Sullivan TR, Sotelo Guerra LJ, Anderson EE, Garrison NA, Baker L, Smith JM, Kraft SA. Equity Concerns Across Pediatric Research Recruitment: An Analysis of Research Staff Interviews. Acad Pediatr 2024; 24:318-329. [PMID: 37442368 PMCID: PMC10782814 DOI: 10.1016/j.acap.2023.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Difficulty recruiting individuals from minoritized and underserved populations for clinical research is well documented and has health equity implications. Previously, we reported findings from interviews with research staff about pediatric research recruitment processes. Respondents raised equity concerns related to recruitment and enrollment of participants from minoritized, low resourced, and underserved populations. We therefore decided to perform a secondary coding of the transcripts to examine equity-related issues systematically. METHODS We conducted a process of secondary coding and analysis of interviews with research staff involved in recruitment for pediatric clinical research. Through consensus we identified codes relevant to equity and developed a conceptual framework including 5 stages of research. RESULTS We analyzed 28 interviews and coded equity-related items. We report 6 implications of our findings. First, inequitable access to clinical care is an upstream barrier to research participation. Second, there is a need to increase research opportunities where underserved and under-represented populations receive care. Third, increasing research team diversity can build trust with patients and families, but teams must ensure adequate support of all research team members. Fourth, issues related to consent processes raise institutional-level opportunities for improvement. Fifth, there are numerous study procedure-related barriers to participation. Sixth, our analysis illustrates that individuals who speak languages other than English face barriers across multiple stages. CONCLUSIONS Research staff members identified equity-related concerns and recommended potential solutions across 5 stages of the research process, which may guide those endeavoring to improve research recruitment for pediatric patients from minoritized and underserved populations.
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Affiliation(s)
- Elliott Mark Weiss
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
| | | | - Laura J Sotelo Guerra
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Emily E Anderson
- Neiswanger Institute for Bioethics (EE Anderson), Loyola University Chicago Stritch School of Medicine, Maywood, Ill
| | - Nanibaa' A Garrison
- Institute for Society and Genetics (NA Garrison), University of California Los Angeles; Institute for Precision Health (NA Garrison), David Geffen School of Medicine, University of California Los Angeles; and Division of General Internal Medicine and Health Services Research (NA Garrison), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Laura Baker
- Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Jodi M Smith
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Research Integration Hub (LJ Sotelo Guerra, L Baker, and JM Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Stephanie A Kraft
- From the Department of Pediatrics (EM Weiss, JM Smith, SA Kraft), University of Washington School of Medicine, Seattle, Wash; Treuman Katz Center for Pediatric Bioethics and Palliative Care (EM Weiss, KM Porter, and SA Kraft), Seattle Children's Research Institute, Seattle, Wash
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2
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Rivers Z, Hyde B, Ronski K, Stearns D, Toll S, Ritt K, Cooney M, Nimeiri H, Federman N, Kaneva K. Exploring Barriers to Pediatric Cancer Clinical Trials: The Role of a Networked, Just-in-Time Study Program. Clin Ther 2023; 45:1148-1150. [PMID: 37783645 DOI: 10.1016/j.clinthera.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
The Research to Accelerate Cures and Equity (RACE) for Children Act mandates that newly developed targeted oncology drugs be tested in children when molecular targets are relevant to pediatric cancers. In its first year, the RACE for Children Act was effective in creating novel drug development opportunities for children with cancer; however, significant barriers to clinical trial enrollment persist. Pediatric cancer clinical trials are impacted by challenges surrounding logistics, complexity, and access. As such, there is potential for a networked and centralized study approach to address these barriers. Here we discuss adapting a just-in-time clinical trial approach for adults to serve the pediatric oncology population. Through innovative patient matching solutions leveraging large, real-world datasets with high computational power, the Tempus Integrated Molecular Evaluation (TIME) for Kids Program aims to address barriers in the development of new therapies. This commentary explores the potential for reducing challenges in developing novel pediatric therapeutics, advancing equity in genomic biomarker testing for precision tailored treatment, and improving outcomes for pediatric oncology patients.
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Affiliation(s)
| | - Ben Hyde
- Tempus Labs, 600 W Chicago, Chicago, IL 60654
| | | | - Duncan Stearns
- University Hospitals Seidman, Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Kevin Ritt
- Tempus Labs, 600 W Chicago, Chicago, IL 60654
| | | | | | - Noah Federman
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles
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3
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Millar MM, Taft T, Weir CR. Clinical trial recruitment in primary care: exploratory factor analysis of a questionnaire to measure barriers and facilitators to primary care providers' involvement. BMC PRIMARY CARE 2022; 23:311. [PMID: 36463123 PMCID: PMC9719201 DOI: 10.1186/s12875-022-01898-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Recruitment of sufficient participants for clinical trials remains challenging. Primary care is an important avenue for patient recruitment but is underutilized. We developed and pilot tested a questionnaire to measure relevant barriers and facilitators to primary care providers' involvement in recruiting patients for clinical trials. METHODS Prior research informed the development of the questionnaire. The initial instrument was revised using feedback obtained from cognitive interviews. We invited all primary care providers practicing within the University of Utah Health system to complete the revised questionnaire. We used a mixed-mode design to collect paper responses via in-person recruitment and email contacts to collect responses online. Descriptive statistics, exploratory factor analysis, Cronbach's alpha, and multivariable regression analyses were conducted. RESULTS Sixty-seven primary care providers participated in the survey. Exploratory factor analysis suggested retaining five factors, representing the importance of clinical trial recruitment in providers' professional identity, clinic-level interventions to facilitate referral, patient-related barriers, concerns about patient health management, and knowledge gaps. The five factors exhibited good or high internal consistency reliability. Professional identity and clinic-level intervention factors were significant predictors of providers' intention to participate in clinical trial recruitment activities. CONCLUSIONS Results of this exploratory analysis provide preliminary evidence of the internal structure, internal consistency reliability, and predictive validity of the questionnaire to measure factors relevant to primary care providers' involvement in clinical trial recruitment.
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Affiliation(s)
- Morgan M. Millar
- grid.223827.e0000 0001 2193 0096Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT USA
| | - Teresa Taft
- grid.223827.e0000 0001 2193 0096Department of Biomedical Informatics, University of Utah, Salt Lake City, UT USA
| | - Charlene R. Weir
- grid.223827.e0000 0001 2193 0096Department of Biomedical Informatics, University of Utah, Salt Lake City, UT USA
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4
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Greenberg RG, McCune S, Attar S, Hovinga C, Stewart B, Lacaze-Masmonteil T. Pediatric Clinical Research Networks: Role in Accelerating Development of Therapeutics in Children. Ther Innov Regul Sci 2022; 56:934-947. [PMID: 36085251 PMCID: PMC9462608 DOI: 10.1007/s43441-022-00453-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/22/2022] [Indexed: 12/20/2022]
Abstract
Background Recent decades have seen many advances in policy and legislation that support the development of drugs used by neonates, infants, children, and young people. This review summarizes the characteristics and performance of networks capable of conducting studies needed to meet regulatory requirements and make advances in pediatric drug development. Methods Description of network goals and capabilities by network leaders. Results In the United States, Europe, Japan, and Canada, clinical research networks have been organized to meet the needs of biopharmaceutical and academic sponsors for timely access to high-quality sites, as well as to provide advice about drug development with regard to strategic and operational feasibility. Each network addresses the specificities of its context while working toward shared principles including standards and timelines; alignment of goals and processes, while not disturbing arrangements for conducting trials that work well; wide geographic coverage; all age groups and pediatric conditions; sources of funding; sites that compete on performance; performance monitoring for benchmarking, and opportunities to optimize the allocation of resources; and education and training for network members. Facilitation in interactions among these networks is based on a single point-of-contact for each; similar approaches to strategic and operational feasibility assessment, and site selection; and collaborative approaches to education and training. Conclusion Within five years, clinical research networks will support the needs of biopharmaceutical and publicly funded pediatric drug development through locally appropriate and globally interoperable approaches.
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Affiliation(s)
- Rachel G Greenberg
- Duke Clinical Research Institute, Durham, NC, USA. .,Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| | - Susan McCune
- Rare Diseases and Pediatrics Center of Excellence, PPD, Part of Thermo Fisher Scientific, Bethesda, MD, USA
| | - Sabah Attar
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Collin Hovinga
- Institute for Advanced Clinical Trials for Children, Rockville, MD, USA
| | - Breanne Stewart
- Quality Management in Clinical Research (QMCR), University of Alberta, Edmonton, AB, Canada
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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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Brewster R, Wong M, Magnani CJ, Gunningham H, Hoffer M, Showalter S, Tran K, Steinberg JR, Turner BE, Goodman SN, Schroeder AR. Early Discontinuation, Results Reporting, and Publication of Pediatric Clinical Trials. Pediatrics 2022; 149:185586. [PMID: 35314864 DOI: 10.1542/peds.2021-052557] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Unique ethical, epidemiological, and economic factors are barriers to performing research in children. The landscape of pediatric clinical trials, including drivers of completion and timely dissemination of results, is not well understood. We aimed to characterize the prevalence of and factors associated with early discontinuation, results reporting, and publication of pediatric clinical trials registered at ClinicalTrials.gov. METHODS Cross-sectional analysis of clinical trials enrolling participants <18 years old registered at ClinicalTrials.gov from October 2007 to March 2020. Multivariable logistic regressions were performed to assess the association between trial characteristics and primary outcomes. Publication data were obtained through PubMed, ClinicalTrials.gov, Embase, and Scopus. RESULTS Overall, 11.1% trials were stopped early, with recruitment failure being the predominant reason for discontinuation. Only 23.5% of completed trials reported results, and 38.8% were published within 3 years of completion. Rates of discontinuation and publication significantly improved over the study period. Among funding sources, government-sponsored trials (adjusted odds ratio [aOR], 0.72; 95% CI, 0.47-0.97) and academic trials (aOR, 0.64; 95% CI, 0.50-0.82) had lower odds of discontinuation compared with industry trials and were more likely to be published (government: aOR, 1.94 [95% CI, 1.52-2.48] academic: aOR, 1.61 [95% CI, 1.35-1.92). Academic trial investigators were the least likely to report results (aOR, 0.34; 95% CI, 0.31-0.52). CONCLUSIONS Early discontinuation and nonreporting/nonpublication of findings remain common in registered pediatric clinical trials and were associated with funding source and other trial features. Targeted efforts are needed to support trial completion and timely results dissemination toward strengthening evidence-based pediatric medicine.
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Affiliation(s)
- Ryan Brewster
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Melissa Wong
- University of Washington School of Medicine, Seattle, Washington
| | - Christopher J Magnani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Madison Hoffer
- University of Washington School of Medicine, Seattle, Washington
| | - Samuel Showalter
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Katherine Tran
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Jecca R Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandon E Turner
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California
| | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Watson SE, Smith P, Snowden J, Vaughn V, Cottrell L, Madden CA, Kong AS, McCulloh R, Stack Lim C, Bledsoe M, Kowal K, McNally M, Knight L, Cowan K, Jimenez EY. Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings: A Scoping Review of the Literature. Clin Transl Sci 2022; 15:838-853. [PMID: 35037409 PMCID: PMC9010274 DOI: 10.1111/cts.13220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022] Open
Abstract
Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for U.S.-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n=23 articles; 85%); fewer (n=10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n=25 studies; 81%) and barriers (n=19; 61%) versus retention facilitators (n=15; 48%) and barriers (n=8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included: contacts/reminders, community engagement and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.
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Affiliation(s)
- Sara E Watson
- Department of Pediatrics, University of Louisville, and Norton Children's Hospital, Louisville, KY
| | | | | | | | | | - Christi A Madden
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alberta S Kong
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE and Children's Hospital & Medical Center, Omaha, NE
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | | | - Karen Kowal
- Nemours Children's Health System, Wilmington, DE
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Kruizinga MD, Essers E, Stuurman FE, Yavuz Y, de Kam ML, Zhuparris A, Janssens HM, Groothuis I, Sprij AJ, Nuijsink M, Cohen AF, Driessen GJA. Clinical validation of digital biomarkers for pediatric patients with asthma and cystic fibrosis - Potential for clinical trials and clinical care. Eur Respir J 2021; 59:13993003.00208-2021. [PMID: 34887326 DOI: 10.1183/13993003.00208-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Digital biomarkers are a promising novel method to capture clinical data in a home-setting. However, clinical validation prior to implementation is of vital importance. The aim of this study was to clinically validate physical activity, heart rate, sleep and FEV1 as digital biomarkers measured by a smartwatch and portable spirometer in children with asthma and cystic fibrosis (CF). METHODS This was a prospective cohort study including 60 children with asthma and 30 children with CF (age 6-16). Participants wore a smartwatch, performed daily spirometry at home and completed a daily symptom questionnaire for 28-days. Physical activity, heart rate, sleep and FEV1 were considered candidate digital endpoints. Data from 128 healthy children was used for comparison. Reported outcomes were compliance, difference between patients and controls, correlation with disease-activity and potential to detect clinical events. Analysis was performed with linear mixed effect models. RESULTS Median compliance was 88%. On average, patients exhibited lower physical activity and FEV1 compared to healthy children, whereas the heart rate of children with asthma was higher compared to healthy children. Days with a higher symptom score were associated with lower physical activity for children with uncontrolled asthma and CF. Furthermore, FEV1 was lower and (nocturnal) heart rate was higher for both patient groups on days with more symptoms. Candidate biomarkers and showed a distinct pattern before- and after a pulmonary exacerbation. CONCLUSION Portable spirometer- and smartwatch-derived digital biomarkers show promise as candidate endpoints for use in clinical trials or clinical care in pediatric lung disease.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, the Netherlands .,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Esmée Essers
- Centre for Human Drug Research, Leiden, the Netherlands.,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Yalçin Yavuz
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | - Hettie M Janssens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Iris Groothuis
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
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Pontrelli G, Ciabattini M, De Crescenzo F, Biondi I, Cocchiola R, Copponi G, Frillici C, Molinari F, Rocchi F, Simonetti A, Rossi P, Livadiotti S. The Investigational Clinical Center: a clinical-supportive and patient-centered trial unit model. Ten years of experience through normal and pandemic times of a large pediatric trial center in Italy. Ital J Pediatr 2021; 47:156. [PMID: 34256815 PMCID: PMC8276228 DOI: 10.1186/s13052-021-01099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence-based medicine relies on appropriately designed, conducted and reported clinical trials (CTs) to provide the best proofs of efficacy and safety for pharmacological and non-pharmacological treatments. Modern clinical research features high complexity and requires a high workload for the management of trials-related activities, often hampering physicians’ participation to clinical trials. Dealing with children in clinical research adds complexity: rare diseases, parents or legal guardian reluctance to engage and recruitment difficulties are major reasons of pediatric trials failure. However, because in pediatrics many treatments are prescribed off-label or are lacking, well-designed clinical trials are particularly needed. Clinical Trial Units (CTUs) are indeed an important asset in the implementation of clinical trials, but their support to investigators is limited to administrative and non-clinical tasks. In this paper we present the model of the Investigational Clinical Center (ICC) of the Bambino Gesù Children’s Hospital in Rome. The ICC includes clinicians supporting the Principal Investigators for clinical management of enrolled patients in compliance of Good Clinical Practice, the legal framework of Clinical Trials. Furthermore, we present 10 years’ experience in pediatric clinical trials and how it has been affected in 2020 by the COVID-19 pandemic. The activity of the ICC has been evaluated according to specific metrics of performance. The ICC model offers a complete support, helping investigators, patients and their families to overcome majority of barriers linked to clinical research, even in time of pandemic. We propose this organization as an innovative model for total-supportive and patient-centered clinical trial implementation.
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Affiliation(s)
- Giuseppe Pontrelli
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Ciabattini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Franco De Crescenzo
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Isabella Biondi
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rossana Cocchiola
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Copponi
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia Frillici
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Molinari
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Rocchi
- INCiPiT (Italian Network for Pediatric Clinical Trials) National Hub, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Simonetti
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicines, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicines, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Livadiotti
- Academic Department of Pediatrics (DPUO), Clinical Trial Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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10
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Kruizinga MD, Moll A, Zhuparris A, Ziagkos D, Stuurman FE, Nuijsink M, Cohen AF, Driessen GJA. Postdischarge Recovery after Acute Pediatric Lung Disease Can Be Quantified with Digital Biomarkers. Respiration 2021; 100:979-988. [PMID: 34004601 DOI: 10.1159/000516328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric patients admitted for acute lung disease are treated and monitored in the hospital, after which full recovery is achieved at home. Many studies report in-hospital recovery, but little is known regarding the time to full recovery after hospital discharge. Technological innovations have led to increased interest in home-monitoring and digital biomarkers. The aim of this study was to describe at-home recovery of 3 common pediatric respiratory diseases using a questionnaire and wearable device. METHODS In this study, patients admitted due to pneumonia (n = 30), preschool wheezing (n = 30), and asthma exacerbation (AE; n = 11) were included. Patients were monitored with a smartwatch and a questionnaire during admission, with a 14-day recovery period and a 10-day "healthy" period. Median compliance was calculated, and a mixed-effects model was fitted for physical activity and heart rate (HR) to describe the recovery period, and the physical activity recovery trajectory was correlated to respiratory symptom scores. RESULTS Median compliance was 47% (interquartile range [IQR] 33-81%) during the entire study period, 68% (IQR 54-91%) during the recovery period, and 28% (IQR 0-74%) during the healthy period. Patients with pneumonia reached normal physical activity 12 days postdischarge, while subjects with wheezing and AE reached this level after 5 and 6 days, respectively. Estimated mean physical activity was closely correlated with the estimated mean symptom score. HR measured by the smartwatch showed a similar recovery trajectory for subjects with wheezing and asthma, but not for subjects with pneumonia. CONCLUSIONS The digital biomarkers, physical activity, and HR obtained via smartwatch show promise for quantifying postdischarge recovery in a noninvasive manner, which can be useful in pediatric clinical trials and clinical care.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Allison Moll
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Maastricht University Medical Centre, Leiden, The Netherlands
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11
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Kruizinga MD, van der Heide N, Moll A, Zhuparris A, Yavuz Y, de Kam ML, Stuurman FE, Cohen AF, Driessen GJA. Towards remote monitoring in pediatric care and clinical trials-Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children. PLoS One 2021; 16:e0244877. [PMID: 33411722 PMCID: PMC7790377 DOI: 10.1371/journal.pone.0244877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Digital devices and wearables allow for the measurement of a wide range of health-related parameters in a non-invasive manner, which may be particularly valuable in pediatrics. Incorporation of such parameters in clinical trials or care as digital endpoint could reduce the burden for children and their parents but requires clinical validation in the target population. This study aims to determine the tolerability, repeatability, and reference values of novel digital endpoints in healthy children. Methods Apparently healthy children (n = 175, 46% male) aged 2–16 were included. Subjects were monitored for 21 days using a home-monitoring platform with several devices (smartwatch, spirometer, thermometer, blood pressure monitor, scales). Endpoints were analyzed with a mixed effects model, assessing variables that explained within- and between-subject variability. Endpoints based on physical activity, heart rate, and sleep-related parameters were included in the analysis. For physical-activity-related endpoints, a sample size needed to detect a 15% increase was calculated. Findings Median compliance was 94%. Variability in each physical activity-related candidate endpoint was explained by age, sex, watch wear time, rain duration per day, average ambient temperature, and population density of the city of residence. Estimated sample sizes for candidate endpoints ranged from 33–110 per group. Daytime heart rate, nocturnal heart rate and sleep duration decreased as a function of age and were comparable to reference values published in the literature. Conclusions Wearable- and portable devices are tolerable for pediatric subjects. The raw data, models and reference values presented here can be used to guide further validation and, in the future, clinical trial designs involving the included measures.
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Affiliation(s)
- M. D. Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - N. van der Heide
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - A. Moll
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - A. Zhuparris
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Y. Yavuz
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M. L. de Kam
- Centre for Human Drug Research, Leiden, The Netherlands
| | - F. E. Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - A. F. Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - G. J. A. Driessen
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
- Maastricht University Medical Centre, Maastricht, The Netherlands
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12
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Noirmain C, Gil-Wey B, Pichon I, Brindel P, Haller G. Factors associated with patient willingness to participate in anaesthesia clinical trials: a vignette-based cross-sectional study. BMC Med Res Methodol 2020; 20:67. [PMID: 32192447 PMCID: PMC7082904 DOI: 10.1186/s12874-020-00949-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trials are essential to improve knowledge of anesthesia and perioperative medicine. Unfortunately, many studies face participant-recruitment issues and fail to include the planned number of participants. There is limited published data about how information delivered about the study or how the experiences and attitudes of prospective participants influence willingness to participate. The purpose of this study was to identify such factors in the domain of anesthesia care. Methods We performed a cross-sectional study at the Geneva University Hospitals (Switzerland) using a newly developed paper-based questionnaire on a sample of outpatients with a recent hospital stay and that were aged over 18 years, confident speaking French and free of any disease that could hinder participation. We explored patient personal factors, such as current health, past exposure to clinical research and anesthesia, as well as study-related factors. Six different scenarios for clinical studies were assessed. Linear regression modeling was used to assess the specific association between personal and study-related factors and willingness to participate in the studies described in the scenarios. Results On the 1318 eligible patients, 398 fully completed the questionnaire. Multivariable adjustment revealed that factors related to altruistic values (β, 9.6, 95% CI 3.4 to 15.7, P = 0.002), to the feeling of benefiting from a more effective treatment (β, 4.7, 95% CI 0.2 to 9.2, P = 0.041) and to the absence of fear about double blinding (β, 5.7, 95% CI 1.3 to 10.2, P = 0.012) were positively associated with willingness to participate. Conversely, concerns about drug-related adverse effects (β, − 11.7, 95% CI − 16.9 to − 6.5, P < 0.001) and anxiety about surgery (β, − 5.2, 95% CI − 10.0 to − 0.5, P = 0.031) were negatively associated with willingness to participate. Conclusion Our study was based on vignettes illustrating typical scenarios of clinical trials performed in anesthesia. However, their similarities with real studies still remains hypothetical and our results should be interpreted as such. Nevertheless, the study contributes to improve understanding of factors that may act as incentives or barriers to participation in clinical trials. It highlights the importance of providing appropriate information and reassurance to patients.
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Affiliation(s)
- Caroline Noirmain
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Isabelle Pichon
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Pauline Brindel
- Clinical Research Center and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Guy Haller
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland. .,Health Services Management and Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004, Australia.
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