Attitudes toward placebo-controlled clinical trials among depressed patients in Japan

Surveys of clinician and patient attitudes to an add-on for in vitro fertilisation

BACKGROUND

Add-ons at the time of in vitro fertilisation (IVF) have become commonplace, despite a general lack of evidence that they are effective and safe. The 'Colorado Protocol' is a commonly used add-on consisting of aspirin, steroid and an antibiotic. Before commencing planning for a clinical trial evaluating the Colorado Protocol, researchers and funders need evidence that the Colorado Protocol is being prescribed, and to be assured that sufficient numbers of participants can be recruited for a clinical trial.

AIMS

To survey fertility clinicians and patients on attitudes toward use of add-ons during IVF, willingness of patients to be randomly assigned to an add-on trial treatment or placebo, and what would be the clinically meaningful outcomes, using the Colorado Protocol as a test case.

MATERIALS AND METHODS

Two online surveys were conducted: clinicians from fertility clinics across the United Kingdom, Australia, and New Zealand; and patients from Auckland-based clinics and NZ patient support groups.

RESULTS

Of 58 clinicians, 44 (75%) had recommended an add-on within the preceding year. Thirty-nine (67%) clinicians were aware of the Colorado Protocol, with 17 (29%) having recommended it within the preceding year. Of the 289 patients, 80% indicated willingness to take trial medications during IVF, and 68% were willing to be randomly assigned to the placebo arm of a trial. The median perceived minimum clinically important difference in live births in both samples was 5%.

CONCLUSIONS

A future trial of this add-on in IVF would be supported by patients in the context of the New Zealand fertility healthcare system.

Attitudes of Chinese Patients with Non-alcoholic Fatty Liver Disease Toward Participation in Clinical Trials from a National Multicenter Survey

BACKGROUND

Many new therapies of non-alcoholic fatty liver disease are being evaluated in clinical trials (CTs), but few of these trials involved sites in China. We evaluated influencing factors of Chinese patients' perspectives in participation in CTs of non-alcoholic fatty liver disease.

METHODS

A questionnaire was designed to be completed by patients with non-alcoholic fatty liver disease at eight affiliated hospitals across China.

RESULTS

428 patients were included in this analysis, 63% were male and median age was 37.9 years (30.0-44.0). 54% patients rated "to help others" and 30% "to improve my health status" as the greatest benefit from CTs. The most important concerns were safety (43%) and patients' benefit (26%). Improving liver fibrosis or cirrhosis (53%) and reducing fat in liver (21%) were desired efficacy of new drugs. Possibility of being treated with a placebo for up to 2-6 years played an influential (21%) or very influential (73%) role on participation. Lower education level, lower body mass index, and cirrhosis were positively associated with acceptance of liver biopsies. Anxiety of adverse effects of the new drug and requirement of 2-3 liver biopsies were negatively associated with patients' attitudes toward participating in the trial.

CONCLUSION

More than one-third of Chinese patients with NAFLD in this survey are willing to participate in CTs of NASH. For CTs of NASH treatment, potential effects on reversing fibrosis or cirrhosis would positively influence, while adverse effects of the new drug and requirement of multiple liver biopsies would negatively influence participation in our study.

Personal preferences for Personalised Trials among patients with chronic diseases: an empirical Bayesian analysis of a conjoint survey

OBJECTIVE

To describe individual patient preferences for Personalised Trials and to identify factors and conditions associated with patient preferences.

DESIGN

Each participant was presented with 18 conjoint questions via an online survey. Each question provided two choices of Personalised Trials that were defined by up to eight attributes, including treatment types, clinician involvement, study logistics and trial burden on a patient.

SETTING

Online survey of adults with at least two common chronic conditions in the USA.

PARTICIPANTS

A nationally representative sample of 501 individuals were recruited from the Chronic Illness Panel by Harris Poll Online. Participants were recruited from several sources, including emails, social media and telephone recruitment of the target population.

MAIN OUTCOME MEASURES

The choice of Personalised Trial design that the participant preferred with each conjoint question.

RESULTS

There was large variability in participants' preferences for the design of Personalised Trials. On average, they preferred certain attributes, such as a short time commitment and no cost. Notably, a population-level analysis correctly predicted 62% of the conjoint responses. An empirical Bayesian analysis of the conjoint data, which supported the estimation of individual-level preferences, improved the accuracy to 86%. Based on estimates of individual-level preferences, patients with chronic pain preferred a long study duration (p≤0.001). Asthma patients were less averse to participation burden in terms of data-collection frequency than patients with other conditions (p=0.002). Patients with hypertension were more cost-sensitive (p<0.001).

CONCLUSION

These analyses provide a framework for elucidating individual-level preferences when implementing novel patient-centred interventions. The data showed that patient preference in Personalised Trials is highly variable, suggesting that individual differences must be accounted for when marketing Personalised Trials. These results have implications for advancing precise interventions in Personalised Trials by indicating when rigorous scientific principles, such as frequent monitoring, is feasible in a substantial subset of patients.

Stressful events and coping strategies associated with symptoms of depression: A Japanese general population survey

BACKGROUND

The following question remains open: what has the strongest impact on symptoms of depression, experiencing multiple stressful events, being exposed to a specific stressful event, or having a maladaptive coping style?

METHOD

We conducted a cross-sectional survey with face-to-face interviews. Data from 2559 randomly-sampled adults living in Japan were analyzed. The participants were asked about stressful events (12 items) experienced in the previous month and their stress-coping strategies (16 items). Presence of symptoms of depression was defined using the Center for Epidemiologic Studies Depression scale. Logistic regression analysis was used to assess the associations of stressful events and stress-coping strategies with symptoms of depression.

RESULTS

The prevalence of symptoms of depression increased with the number of stressful events. Eight stressful events and five stress-coping strategies were positively associated with symptoms of depression. In the multiple logistic regression analysis for the items that showed a significant association with symptoms of depression, two stressful events ("Health/illness of self" and "Trouble with family members") and two stress-coping strategies ("Smoking" and "Bearing without action") remained significantly associated with symptoms of depression; however, the "dose effect" of the number of stressful events disappeared, suggesting that these stressful events and stress-coping strategies have a stronger association with symptoms of depression compared with experiencing multiple stressful events.

LIMITATIONS

Since this study was cross-sectional in design, causal relationships could not be determined.

CONCLUSION

Our findings may indicate the importance of focusing on types of stressful events and coping styles in developing preventive strategies for major depression.