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Akimoto K, Taparra K, Brown T, Patel MI. Diversity in Cancer Care: Current Challenges and Potential Solutions to Achieving Equity in Clinical Trial Participation. Cancer J 2023; 29:310-315. [PMID: 37963364 DOI: 10.1097/ppo.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Access to and participation in cancer clinical trials determine whether such data are applicable, feasible, and generalizable among populations. The lack of inclusion of low-income and marginalized populations limits generalizability of the critical data guiding novel therapeutics and interventions used globally. Such lack of cancer clinical trial equity is troubling, considering that the populations frequently excluded from these trials are those with disproportionately higher cancer morbidity and mortality rates. There is an urgency to increase representation of marginalized populations to ensure that effective treatments are developed and equitably applied. Efforts to ameliorate these clinical trial inclusion disparities are met with a slew of multifactorial and multilevel challenges. We aim to review these challenges at the patient, clinician, system, and policy levels. We also highlight and propose solutions to inform future efforts to achieve cancer health equity.
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Affiliation(s)
- Kai Akimoto
- From the Duluth Campus, University of Minnesota School of Medicine, Duluth, MN
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA
| | - Thelma Brown
- Division of Hematology and Oncology, The University of Alabama at Birmingham, AL
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2
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Nagla A, Le B, White C, V Kiburg K, Philip J. Attitudes of Palliative Care Practitioners Towards Enrolling Patients in Clinical Trials. J Palliat Care 2022; 37:447-455. [PMID: 35546098 DOI: 10.1177/08258597211063057] [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: 11/16/2022]
Abstract
Background: Recruitment of participants for clinical trials remains a key consideration for investigators. This is particularly relevant in palliative care, where practitioners are sometimes reluctant to refer patients for consideration of enrolment. Reasons for this reluctance range from concerns about excessive burden to patients, through to debate about the appropriateness of undertaking trials in the palliative care setting. Aim: The aim of this study was (1) to explore palliative care practitioners' attitudes and views of clinical trials, (2) to compare these findings with those of a similar survey undertaken more than a decade earlier, and (3) to explore predictors associated with key concepts of interest associated with clinical trials. Design: The palliative care clinician's attitudes to clinical research survey undertaken in 2007 formed the basis of a repeat survey conducted in 2019. Setting/Participants: Australian and New Zealand palliative care practitioners were surveyed. Results: Surveys were completed by 135 palliative care practitioners. Comparing results of the current study and those findings of more than a decade earlier revealed that attitudes have either not substantially changed or indeed in some areas have become less accepting of clinical trials. This is despite the dramatic increase in the volume of research carried out within palliative care over the last decade. Conclusion: Our survey suggests that the reasons for engagement in research are complex and likely to differ according to local conditions. Careful attention to understanding of the local environment and particularly the attitudes of local practitioners is likely to be essential to be successful in this endeavour.
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Affiliation(s)
- Ahmed Nagla
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Clare White
- Northern Ireland Hospice, Belfast, Northern Ireland and Belfast Health and Social Care Trust
| | | | - Jennifer Philip
- Peter MacCallum Cancer Centre, Melbourne, Australia.,St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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3
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Braun-Inglis C, Shvetsov YB, Springer A, Ferguson V, Workman T, Omatsu DA, Conde F, Bantum EO, Rhee J. Understanding Attitudes and Roles of Oncology Advanced Practitioners in the Setting of Cancer Clinical Trials: A Pilot Study. J Adv Pract Oncol 2021; 12:465-476. [PMID: 34430057 PMCID: PMC8299791 DOI: 10.6004/jadpro.2021.12.5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Oncology advanced practitioners (APs), including nurse practitioners, physician assistants, clinical nurse specialists, and pharmacists, are skilled health-care providers who contribute significantly to quality cancer care. However, little is known about how APs function within the clinical trials arena. With low rates of clinical trial enrollment among the adult oncology patient population, APs could play an important role in improving clinical trial enrollment. METHODS A descriptive cross-sectional study was conducted based on a 57-item survey of oncology APs' attitudes, beliefs, and roles in relation to cancer clinical trials. RESULTS To assess validity and internal consistency of the survey, a pilot data collection was completed on 14 respondents from Hawaii. The survey's internal consistency across the subscales was moderate to very high, with Cronbach's alpha ranging between 0.55 and 0.86. The majority of oncology APs were interested in being more involved in the clinical trials process, and many are registered as investigators through the National Cancer Institute (NCI). However, few respondents reported being involved in recruitment, consenting, protocol development, or being actively involved with a research base. CONCLUSIONS This survey was found to be a valid tool to measure APs' attitudes and roles in regards to clinical trials. This survey is just the beginning of data collection in regards to clinical trials among this group of health-care professionals. RECOMMENDATIONS To gain further insight into oncology APs and their roles in clinical trials, it is recommended that this survey be implemented on a national level as a first step in moving this issue forward.
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Affiliation(s)
- Christa Braun-Inglis
- University of Hawaii School of Nursing and Dental Hygiene, Honolulu, Hawaii
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | | | | | | | | | | | | | - Jessica Rhee
- University of Hawaii Cancer Center, Honolulu, Hawaii
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Conefrey C, Donovan JL, Stein RC, Paramasivan S, Marshall A, Bartlett J, Cameron D, Campbell A, Dunn J, Earl H, Hall P, Harmer V, Hughes-Davies L, Macpherson I, Makris A, Morgan A, Pinder S, Poole C, Rea D, Rooshenas L. Strategies to Improve Recruitment to a De-escalation Trial: A Mixed-Methods Study of the OPTIMA Prelim Trial in Early Breast Cancer. Clin Oncol (R Coll Radiol) 2020; 32:382-389. [PMID: 32089356 PMCID: PMC7246331 DOI: 10.1016/j.clon.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
AIMS De-escalation trials are challenging and sometimes may fail due to poor recruitment. The OPTIMA Prelim randomised controlled trial (ISRCTN42400492) randomised patients with early stage breast cancer to chemotherapy versus 'test-directed' chemotherapy, with a possible outcome of no chemotherapy, which could confer less treatment relative to routine practice. Despite encountering challenges, OPTIMA Prelim reached its recruitment target ahead of schedule. This study reports the root causes of recruitment challenges and the strategies used to successfully overcome them. MATERIALS AND METHODS A mixed-methods recruitment intervention (QuinteT Recruitment Intervention) was used to investigate the recruitment difficulties and feedback findings to inform interventions and optimise ongoing recruitment. Quantitative site-level recruitment data, audio-recorded recruitment appointments (n = 46), qualitative interviews (n = 22) with trialists/recruiting staff (oncologists/nurses) and patient-facing documentation were analysed using descriptive, thematic and conversation analyses. Findings were triangulated to inform a 'plan of action' to optimise recruitment. RESULTS Despite best intentions, oncologists' routine practices complicated recruitment. Discomfort about deviating from the usual practice of recommending chemotherapy according to tumour clinicopathological features meant that not all eligible patients were approached. Audio-recorded recruitment appointments revealed how routine practices undermined recruitment. A tendency to justify chemotherapy provision before presenting the randomised controlled trial and subtly indicating that chemotherapy would be more/less beneficial undermined equipoise and made it difficult for patients to engage with OPTIMA Prelim. To tackle these challenges, individual and group recruiter feedback focussed on communication issues and vignettes of eligible patients were discussed to address discomforts around approaching patients. 'Tips' documents concerning structuring discussions and conveying equipoise were disseminated across sites, together with revisions to the Patient Information Sheet. CONCLUSIONS This is the first study illuminating the tension between oncologists' routine practices and recruitment to de-escalation trials. Although time and resources are required, these challenges can be addressed through specific feedback and training as the trial is underway.
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Affiliation(s)
- C Conefrey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - J L Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - R C Stein
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - S Paramasivan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - A Marshall
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - D Cameron
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - A Campbell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Earl
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P Hall
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - V Harmer
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - I Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Makris
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - A Morgan
- Independent Cancer Patients' Voice, London, UK
| | - S Pinder
- King's College London, Comprehensive Cancer Centre at Guy's Hospital, London, UK
| | - C Poole
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Rea
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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5
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Peng W, Occa A, McFarlane SJ, Morgan SE. A Content Analysis of the Discussions about Clinical Trials on A Cancer-dedicated Online Forum. JOURNAL OF HEALTH COMMUNICATION 2019; 24:912-922. [PMID: 31709917 DOI: 10.1080/10810730.2019.1688895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Enrollment rates of cancer clinical trials remain low, affecting the delivery of effective medical treatments. Recent research has documented common factors affecting trial participation, but to improve these efforts more studies are needed to further understand specific concerns and issues of potential participants in multiple contexts. Forums and other online peer-to-peer health communities are crucial to the coping and survivorship of cancer patients. Online health communities will offer valuable information to understand how patients discuss perceptions, motivations, and challenges associated with clinical trial participation, and to understand how patients provide support to each other. The present study conducted a content analysis of 270 posts shared by 154 unique users between August 2017 and January 2018 on a popular online breast cancer forum. The analysis identifies common characteristics of patient users, salient post themes, perceived barriers, emotions, and misconceptions regarding clinical trial participation. The study findings are generally consistent with previous studies but provide in-depth insights into online support between cancer patients about clinical trial participation. Implications for practice and future research are also discussed.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida, USA
| | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky, USA
| | | | - Susan E Morgan
- School of Communication, University of Miami, Coral Gables, Florida, USA
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6
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Mahmud A, Zalay O, Springer A, Arts K, Eisenhauer E. Barriers to participation in clinical trials: a physician survey. ACTA ACUST UNITED AC 2018; 25:119-125. [PMID: 29719427 DOI: 10.3747/co.25.3857] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation. Methods To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions. Results The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services. Conclusions The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.
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Affiliation(s)
| | | | - A Springer
- Department of Health Sciences, Queen's University, Kingston, ON
| | - K Arts
- Canadian Cancer Clinical Trials Network, Toronto, ON
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Glasbey JC, Magill EL, Brock K, Bach SP. Recommendations for Randomised Trials in Surgical Oncology. Clin Oncol (R Coll Radiol) 2017; 29:799-810. [PMID: 29097072 DOI: 10.1016/j.clon.2017.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
Trials of surgical procedures in the treatment of malignant disease face a unique set of challenges. This review aimed to describe recommendations for the design, delivery and reporting of randomised trials in surgical oncology. A literature search was carried out without date limits to identify articles related to trial methodology research in surgery and surgical oncology. A narrative review was framed around two open National Institute of Health Research portfolio trials in colon and rectal cancer: the STAR-TREC trial (ISRCTN14240288) and the ROCCS trial (ISRCTN46330337). Twelve specific challenges were highlighted: standardisation of technique; pilot and feasibility studies; balancing treatments; the recruitment pathway; outcome measures; patient and public representation; trainee-led networks; randomisation; novel techniques and training; learning curves; blinding; follow-up. Evidence-based recommendations were made for the future design and conduct of surgical oncology trials. Better understanding of the challenges facing trials in the surgical treatment of cancer will accelerate high-quality evaluation and rapid adoption of innovation for the benefit of patient care.
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Affiliation(s)
- J C Glasbey
- Academic Department of Surgery, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - E L Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - K Brock
- Devices, Drugs, Diagnostics and Biomarkers (D3B), Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - S P Bach
- Academic Department of Surgery, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Devices, Drugs, Diagnostics and Biomarkers (D3B), Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
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8
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Gruen ME, Griffith EH, Caney SMA, Rishniw M, Lascelles BDX. Attitudes of small animal practitioners toward participation in veterinary clinical trials. J Am Vet Med Assoc 2017; 250:86-97. [PMID: 28001115 DOI: 10.2460/javma.250.1.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine attitudes of small animal practitioners toward veterinary clinical trials and variables influencing their likelihood of participating in such trials. DESIGN Cross-sectional survey. SAMPLE Small animal practitioners with membership in 1 of 2 online veterinary communities (n = 163 and 652). PROCEDURES An online survey was developed for each of 2 veterinary communities, and invitations to participate were sent via email. Each survey included questions designed to collect information on the respondents' willingness to enroll their patients in clinical trials and to recommend participation to clients for their pets. RESULTS More than 80% of respondents to each survey indicated that they spend no time in clinical research. A high proportion of respondents were likely or extremely likely to recommend clinical trial participation to clients for their pets when those trials involved treatments licensed in other countries, novel treatments, respected investigators, or sponsoring by academic institutions, among other reasons. Reasons for not recommending participation included distance, time restrictions, and lack of awareness of ongoing clinical trials; 28% of respondents indicated that they did not usually learn about such clinical trials. Most respondents (79% to 92%) rated their recommendation of a trial as important to their client's willingness to participate. CONCLUSIONS AND CLINICAL RELEVANCE Participation in veterinary clinical trials by small animal practitioners and their clients and patients appeared low. Efforts should be increased to raise practitioner awareness of clinical trials for which patients might qualify. Specific elements of trial design were identified that could be modified to increase participation.
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9
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van den Bor RM, Grobbee DE, Oosterman BJ, Vaessen PWJ, Roes KCB. Predicting enrollment performance of investigational centers in phase III multi-center clinical trials. Contemp Clin Trials Commun 2017; 7:208-216. [PMID: 29696188 PMCID: PMC5898520 DOI: 10.1016/j.conctc.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/07/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022] Open
Abstract
Failure to meet subject recruitment targets in clinical trials continues to be a widespread problem with potentially serious scientific, logistical, financial and ethical consequences. On the operational level, enrollment-related issues may be mitigated by careful site selection and by allocating monitoring or training resources proportionally to the anticipated risk of poor enrollment. Such procedures require estimates of the expected recruitment performance that are sufficiently reliable to allow centers to be sensibly categorized. In this study, we investigate whether information obtained from feasibility questionnaires can potentially be used to predict which centers will and which centers will not meet their enrollment targets by means of multivariable logistic regression analysis. From a large set of 59 candidate predictors, we determined the subset that is optimal for predictive purposes using Least Absolute Shrinkage and Selection Operator (LASSO) regularization. Although the extent to which the results are generalizable remains to be determined, they indicate that the prediction accuracy of the optimal model is only a marginal improvement over the intercept-only model, illustrating the difficulty of prediction in this setting.
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Affiliation(s)
- Rutger M van den Bor
- Julius Clinical Ltd., Broederplein 41-43, 3703 CD Zeist, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Clinical Ltd., Broederplein 41-43, 3703 CD Zeist, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Bas J Oosterman
- Julius Clinical Ltd., Broederplein 41-43, 3703 CD Zeist, The Netherlands
| | - Petrus W J Vaessen
- Julius Clinical Ltd., Broederplein 41-43, 3703 CD Zeist, The Netherlands
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Massett HA, Dilts DM, Bailey R, Berktold J, Ledsky R, Atkinson NL, Mishkin G, Denicoff A, Padberg RM, Allen MP, Silver K, Carrington K, Johnson LE. Raising Public Awareness of Clinical Trials: Development of Messages for a National Health Communication Campaign. JOURNAL OF HEALTH COMMUNICATION 2017; 22:373-385. [PMID: 28339327 DOI: 10.1080/10810730.2017.1290715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Clinical trials are essential for developing new and effective treatments and improving patient quality of life; however, many trials cannot answer their primary research questions because they fall short of their recruitment goals. This article reports the results of formative research conducted in two populations, the public and primary care physicians, to identify messages that may raise awareness and increase interest in clinical trials and be used in a national communication campaign. Results suggested that participants were primarily motivated to participate in clinical trials out of a self-interest to help themselves first. Messages illustrated that current treatments were tested via clinical trials, helped normalize trials as routine practices, and reduced concerns over trying something new first. Participants wanted messages that portray trials as state-of-the-art choices that offer some hope, show people like themselves, and are described in a clear, concise manner with actionable steps for them to take. The study revealed some differences in message salience, with healthy audiences exhibiting lower levels of interest. Our results suggest that targeted messages are needed, and that communication with primary health-care providers is an important and necessary component in raising patient awareness of the importance of clinical trials.
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Affiliation(s)
- Holly A Massett
- a Cancer Therapy Evaluation Program, Division of Cancer Treatment & Diagnosis , National Cancer Institute , Bethesda , Maryland , USA
| | | | - Robert Bailey
- c SalterMitchell/Marketing for Change , Alexandria , Virginia , USA
| | | | | | | | - Grace Mishkin
- a Cancer Therapy Evaluation Program, Division of Cancer Treatment & Diagnosis , National Cancer Institute , Bethesda , Maryland , USA
| | - Andrea Denicoff
- a Cancer Therapy Evaluation Program, Division of Cancer Treatment & Diagnosis , National Cancer Institute , Bethesda , Maryland , USA
| | | | - Marin P Allen
- h Office of Communications and Public Liaison, Office of the Director , National Institutes of Health , Bethesda , Maryland , USA
| | - Karen Silver
- i Office of the Assistant Secretary for Health , U. S. Department of Health and Human Services , Washington , DC , USA
| | - Kelli Carrington
- j National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda , Maryland , USA
| | - Lenora E Johnson
- k National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , Maryland , USA
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11
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Morgan SE, Occa A, Mouton A, Potter J. The Role of Nonverbal Communication Behaviors in Clinical Trial and Research Study Recruitment. HEALTH COMMUNICATION 2017; 32:461-469. [PMID: 27314155 DOI: 10.1080/10410236.2016.1140266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Few studies have examined the communication behaviors of those who recruit for clinical trials and research studies, particularly of nonmedical professionals who often do the bulk of recruiting. This focus-group study of 63 recruiters analyzes the ways in which nonverbal communication behaviors support the process of recruitment, using the lens of communication accommodation theory. Results indicate that recruiters first "read" potential study participants' nonverbal communication for clues about their state of mind, then use nonverbal communication to achieve a sense of convergence. Specific nonverbal communication behaviors were discussed by recruiters, including smiling, variations in the use of voice, adjusting body position, the appropriate use of physical touch, the management of eye contact, and the effect of clothing and physical appearance. Implications for recruitment practice are discussed.
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Affiliation(s)
| | - Aurora Occa
- a School of Communication , University of Miami
| | - Ashton Mouton
- b Brian Lamb School of Communication , Purdue University
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12
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Morgan SE, Occa A, Potter J, Mouton A, Peter ME. "You Need to Be a Good Listener": Recruiters' Use of Relational Communication Behaviors to Enhance Clinical Trial and Research Study Accrual. JOURNAL OF HEALTH COMMUNICATION 2017; 22:95-101. [PMID: 28085636 DOI: 10.1080/10810730.2016.1256356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Medical and research professionals who discuss clinical trials and research studies with potential participants face an often daunting challenge, particularly when recruiting from minority and underserved populations. This study reports on findings from a focus group study of 63 research coordinators, study nurses, professional recruiters, and other professionals in Indianapolis, IN and Miami, FL who work to recruit from minority and underserved populations. These professionals discussed the importance of creating a sense of connection with potential participants as part of the recruitment and retention process. Building a relationship, however fleeting, involved a number of concrete behaviors, including listening to personal information, expressing empathy, and then providing reciprocal self-disclosures; having repeated contact, usually by working in the same environment over an extended period of time; demonstrating respect through politeness and the use of honorifics; going the extra mile for participants; offering flexibility in scheduling follow-up appointments; and creating a sense of personal and community trust by being truthful. The implications of these findings for clinical trial and research study accrual are discussed.
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Affiliation(s)
- Susan E Morgan
- a School of Communication , University of Miami , Coral Gables , Florida , USA
| | - Aurora Occa
- a School of Communication , University of Miami , Coral Gables , Florida , USA
| | - JoNell Potter
- b Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - Ashton Mouton
- c Brian Lamb School of Communication , Purdue University , West Lafayette , Indiana , USA
| | - Megan E Peter
- d Department of Health Behavior and Policy , Virginia Commonwealth University , Richmond , Virginia , USA
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13
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Simoni ZR, Martin M, Wenzel JA, Cook ED, Konety B, Vickers SM, Chen MS, Foaud MN, Durant RW. A Qualitative Study of Motivations for Minority Recruitment in Cancer Clinical Trials Across Five NCI-Designated Cancer Centers. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0303-3. [PMID: 27826818 PMCID: PMC6110968 DOI: 10.1007/s40615-016-0303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Minority enrollment in cancer clinical trials is traditionally low. In light of this fact, numerous studies have investigated barriers to recruitment and retention within minority populations. However, very little research has investigated the importance of clinicians' and researchers' motivations for minority recruitment in cancer clinical trials. Therefore, we sought to examine motivations for minority recruitment across four professional stakeholder groups (principal investigators, clinicians, research staff, and Cancer Center leaders) at five National Cancer Institute (NCI)-designated Comprehensive Cancer Centers. METHODS This study is based on the data from 91 qualitative interviews conducted across the five NCI-designated Comprehensive Cancer Centers to investigate stakeholders' motivations for minority recruitment in cancer clinical trials. RESULTS Emergent themes include (a) minority recruitment increases generalizability of cancer clinical trials, (b) minority recruitment is motivated by social justice, (c) some institutions promote minority recruitment through the use of supplemental financial support, (d) federal funding requirements for minority inclusion in clinical research motivate investigators to focus on minority recruitment, and (e) some stakeholders favor a more race-neutral approach to participant recruitment rather than an emphasis on targeted minority recruitment. CONCLUSION The perspectives of clinical and research stakeholders potentially inform the assessment of existing strategies and the development of new strategies to increase motivation for minority recruitment in cancer clinical trials.
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Affiliation(s)
| | | | | | | | | | | | - Moon S Chen
- University of Texas at Dallas, Dallas, TX, USA
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14
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Francis A, Bartlett J, Rea D, Pinder S, Stein R, Stobart H, Purdie C, Rakha E, Thompson A, Shaaban A. Viewpoint: Availability of oestrogen receptor and HER2 status for the breast multidisciplinary meeting discussion; time to get it right. Eur J Surg Oncol 2016; 42:994-8. [DOI: 10.1016/j.ejso.2016.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/28/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022] Open
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15
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Caixeiro NJ, Byun HL, Descallar J, Levesque JV, de Souza P, Soon Lee C. Health professionals' opinions on supporting a cancer biobank: identification of barriers to combat biobanking pitfalls. Eur J Hum Genet 2016; 24:626-32. [PMID: 26328505 PMCID: PMC4930095 DOI: 10.1038/ejhg.2015.191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 06/17/2015] [Accepted: 07/28/2015] [Indexed: 11/08/2022] Open
Abstract
Although rarely acknowledged, a successful biobank is highly dependent on the support of the health professionals who assist the biobank in all aspects of its activities. In many cases, the lack of health professional support can be a limiting factor in the biobanking process of collecting and processing high-quality biospecimens. The aim of this study was to determine the attitudes of health professionals towards cancer biobanking. Using a 5-point Likert scale questionnaire, important aspects of biobanking, including accrual, quality, knowledge, responsiveness, impact, access, trust, governance and accreditation, were investigated. In total, 95 of 124 health and medical practitioners who were approached participated in this study (77% response rate). Health professionals in general supported the aims of biobanking with 56% of participants showing willingness to create a biobank and recruit donors (accrual), 85% understanding the importance in the storage and distribution of biospecimens (quality), 88% having an appreciation for the role of a biobank in furthering cancer research (knowledge), 70% showing awareness of the use of biospecimens in future research initiatives (responsiveness) and 73% demonstrating support for a biobank with proper control, authority and credibility measures in place (governance and accreditation). Overall, provided that proper information about the activities of the biobank and researcher access was transparent, health professionals were very willing to support cancer biobanking. These findings may assist in developing strategies for the establishment and maintenance of biobanks and aid the implementation of more effective policies and procedures to embed biobanking into routine hospital practices.
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Affiliation(s)
- Nicole J Caixeiro
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Discipline of Pathology, School of Medicine, University of Western Sydney, Liverpool, NSW, Australia
| | - Hei Lan Byun
- Department of Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Janelle V Levesque
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Psycho-Oncology Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Paul de Souza
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Discipline of Pathology, School of Medicine, University of Western Sydney, Liverpool, NSW, Australia
- Department of Oncology, Liverpool Hospital, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cheok Soon Lee
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Discipline of Pathology, School of Medicine, University of Western Sydney, Liverpool, NSW, Australia
- Department of Oncology, Liverpool Hospital, Liverpool, NSW, Australia
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Otado J, Kwagyan J, Edwards D, Ukaegbu A, Rockcliffe F, Osafo N. Culturally Competent Strategies for Recruitment and Retention of African American Populations into Clinical Trials. Clin Transl Sci 2015; 8:460-6. [PMID: 25974328 PMCID: PMC4626379 DOI: 10.1111/cts.12285] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To identify successful recruitment strategies, challenges and best practices for researchers to engage African American communities in clinical studies taken into consideration target participants' culture and context. METHODS We reviewed 50 studies conducted from 2001 to 2012 at an inner-city research center to determine the type, duration, anticipated enrollments and actual enrollments. Survey was sent to study coordinators to obtain data on recruitment and retention strategies, challenges and dropout rates. We also interviewed 25 study coordinators on challenges and strategies. RESULTS Of the 50 studies, 24 had completed recruitment at the time of this report. The completed studies achieved a median recruitment rate of 88% (range: 50-110). Successful recruitment and retention strategies included: field-based strategy and snowballing. Major barriers were: distrust, compensation, education disadvantage, lack of interest, and inability to have study partner. Strategies to reduce barriers included providing informational sessions, disseminating newsletters about study outcomes. Best practices include being culturally sensitive including demonstrating a caring attitude and being responsive to participants needs. CONCLUSIONS Cultural competence is critical in order to design and implement successful recruitment strategies in this population. Research teams should consist of multiethnic staff, involve the community, demonstrate trust and deliver concise education of the research endeavor.
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Affiliation(s)
- Jane Otado
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - John Kwagyan
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Diana Edwards
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Alice Ukaegbu
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Faun Rockcliffe
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
| | - Nana Osafo
- Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), Howard University, College of Medicine, Washington, District of Columbia, USA
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Mc Grath-Lone L, Day S, Schoenborn C, Ward H. Exploring research participation among cancer patients: analysis of a national survey and an in-depth interview study. BMC Cancer 2015; 15:618. [PMID: 26341736 PMCID: PMC4560870 DOI: 10.1186/s12885-015-1628-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/27/2015] [Indexed: 11/16/2022] Open
Abstract
Background Inequalities in cancer research participation are thought to exist with certain groups under-represented in research populations; however, much of the evidence is based on small-scale studies. The aim of this study was to explore data from in-depth interviews with cancer patients and a large national survey to investigate variation in who is asked to participate in research and who takes part. Methods Factors associated with research discussion and participation were explored in National Cancer Patient Experience Survey data using multivariate logistic regression and during in-depth interviews with 25 breast cancer patients. Results Survey data were available for 66,953 cancer patients; 30.4 % reported having discussions about, and 18.9 % took part in, research. Barriers to participation at staff, patient and trust level were evident; for example, staff were less likely to discuss research with older patients, Asian and black patients were less likely to take part and patients treated at specialist or teaching trusts had higher levels of discussion and participation. Interviews showed that patients’ willingness to participate changed over time and was not synonymous with participation as some were ineligible. Conclusion Some patient groups were less likely to have discussions about or participate in research. Analysis of this variation vis-à-vis the composition of the patient population may be useful to ensure that there is equity regarding the potential benefits of research participation and that research findings are applicable to target populations in the translational model.
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Affiliation(s)
- Louise Mc Grath-Lone
- Patient Experience Research Centre, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
| | - Sophie Day
- Patient Experience Research Centre, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
| | - Claudia Schoenborn
- Patient Experience Research Centre, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
| | - Helen Ward
- Patient Experience Research Centre, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
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Adams M, Caffrey L, McKevitt C. Barriers and opportunities for enhancing patient recruitment and retention in clinical research: findings from an interview study in an NHS academic health science centre. Health Res Policy Syst 2015; 13:8. [PMID: 25971302 PMCID: PMC4429658 DOI: 10.1186/1478-4505-13-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/07/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the UK, the recruitment of patients into clinical research is a national health research and development policy priority. There has been limited investigation of how national level factors operate as barriers or facilitators to recruitment work, particularly from the perspective of staff undertaking patient recruitment work. The aim of this study is to identify and examine staff views of the key organisational barriers and facilitators to patient recruitment work in one clinical research group located in an NHS Academic Health Science Centre. METHODS A qualitative study utilizing in-depth, one-to-one semi-structured interviews with 11 purposively selected staff with particular responsibilities to recruit and retain patients as clinical research subjects. Thematic analysis classified interview data by recurring themes, concepts, and emergent categories for the purposes of establishing explanatory accounts. RESULTS The findings highlight four key factors that staff perceived to be most significant for the successful recruitment and retention of patients in research and identify how staff located these factors within patients, studies, the research centre, the trust, and beyond the trust. Firstly, competition for research participants at an organisational and national level was perceived to undermine recruitment success. Secondly, the tension between clinical and clinical research workloads was seen to interrupt patient recruitment into studies, despite national funding arrangements to manage excess treatment costs. Thirdly, staff perceived an imbalance between personal patient burden and benefit. Ethical committee regulation, designed to protect patients, was perceived by some staff to detract from clarification and systematisation of incentivisation strategies. Finally, the structure and relationships within clinical research teams, in particular the low tacit status of recruitment skills, was seen as influential. CONCLUSIONS The results of this case-study, conducted in an exemplary NHS academic research centre, highlight current systematic challenges to patient recruitment and retention in clinical studies more generally as seen from the perspective of staff at the 'sharp end' of recruiting. Staff experience is that, beyond individual clinical research design and protocol factors, wider organisational and extra-organisational norms, structures, and processes operate as significant facilitators or hindrances in the recruitment of patients as research subjects.
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Affiliation(s)
- Mary Adams
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
| | - Louise Caffrey
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
| | - Christopher McKevitt
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
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Entwicklung von Aufklärungsmaterialien für die „Deutsche Prostatakrebsstudie PREFERE“. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:28-39. [DOI: 10.1016/j.zefq.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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D'Alimonte L, Deabreu A, Marquez A, Mamedov A, Loblaw A. Improving clinical trial accrual through a novel feedback approach: Lessons learned from a single disease site group. Pract Radiat Oncol 2014; 5:70-3. [PMID: 25413410 DOI: 10.1016/j.prro.2014.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Physician participation is critical for the success of clinical trials. Many efforts have been made to aid physicians with accrual. The aim of our study was to determine what impact a new feedback initiative had on clinical trial accrual and recruitment within a large disease site group. METHODS AND MATERIALS A novel feedback initiative was implemented within a large multidisciplinary disease site group. Feedback on trial recruitment by physician and by study for the month and year to date was formally presented at the end of each trial month at weekly tumor board meetings. In addition, the feedback was sent via email. Trial recruitment was assessed both preintervention and postintervention. RESULTS A 9-month reporting period both preintervention and postintervention are reported. Total accruals within each observation window were 79 versus 209 patients, respectively. Preintervention, the mean number of patients accrued per month was 8.44 (range, 2-16). Postintervention, the mean number of patients accrued was 23.2 (range, 14-48). Preintervention, physicians only accrued to trials within their specialty. Postintervention, this improved by 4% monthly. CONCLUSIONS Physicians play a key role in the success of clinical trials. By adopting a simple monthly feedback communication initiative, we were able to improve clinical trial accruals. Long-term assessment is required to understand longitudinal impact on accrual rates.
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Affiliation(s)
- Laura D'Alimonte
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Andrea Deabreu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arlynne Marquez
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Health Policy, Measurement and Evaluation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Sharrocks K, Spicer J, Camidge DR, Papa S. The impact of socioeconomic status on access to cancer clinical trials. Br J Cancer 2014; 111:1684-7. [PMID: 25093493 PMCID: PMC4453719 DOI: 10.1038/bjc.2014.108] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/02/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022] Open
Abstract
Cancer clinical trials enable the development of novel agents for the potential benefit of cancer patients. Enrolment in a trial offers patients the chance of superior efficacy coupled to the risk of unanticipated toxicity. For trial results to be generalisable, the data need to be collected in patients' representative of the general cancer population. Socioeconomic deprivation is associated with poor cancer outcomes. In the developed world, the gap between the most and least deprived is widening. This mini-review explores the evidence regarding socioeconomics and access to cancer trials, highlighting the underrepresentation of deprived patients, and exploring reasons for this disparity.
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Affiliation(s)
- K Sharrocks
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - J Spicer
- Department of Medicine, King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK
| | - D R Camidge
- Developmental Therapeutics Program, University of Colorado Cancer Center, Aurora, CO 80045, USA
| | - S Papa
- Department of Medicine, King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK
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Chalela P, Suarez L, Muñoz E, Gallion KJ, Pollock BH, Weitman SD, Karnad A, Ramirez AG. Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2014; 4:1000281. [PMID: 25077043 PMCID: PMC4112537 DOI: 10.4172/2161-0711.1000281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities' disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients' decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research. METHODS An interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity. RESULTS For one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier. CONCLUSION This study, one of the first to identify South Texas patients' barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos' likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | | | - Edgar Muñoz
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Kipling J Gallion
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Brad H Pollock
- Department of Epidemiology and Biostatistics The University of Texas Health Science Center at San Antonio 7703 Floyd Curl Ave., Mail Code 7933 San Antonio, TX 78229-3901
| | - Steven D Weitman
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Anand Karnad
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Amelie G Ramirez
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
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Newington L, Metcalfe A. Researchers' and clinicians' perceptions of recruiting participants to clinical research: a thematic meta-synthesis. J Clin Med Res 2014; 6:162-72. [PMID: 24734142 PMCID: PMC3985558 DOI: 10.14740/jocmr1619w] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 11/16/2022] Open
Abstract
Background Recruiting the desired number of research participants is frequently problematic with resulting financial and clinical implications. The views of individuals responsible for participant recruitment have not been previously reviewed. This systematic review and thematic meta-synthesis explores researchers’ and clinicians’ experiences and perceptions of recruiting participants to clinical research, with the aim of informing improved recruitment systems and strategies. Methods Studies published between January 1995 and May 2013 were identified from: Ovid MEDLINE, Ovid EMBASE, Ovid PSYCHINFO, ASSIA, British Nursing Index, Scopus, Web of Science, CINAHL and PubMed. Included studies were original peer reviewed research, with qualitative methodologies and an aim of exploring the views of clinicians and/or researchers on recruitment to clinical research. Studies discussing the recruitment of patients unable to give informed consent were excluded. The findings sections of the relevant studies were free coded to identify key concepts which were grouped into hierarchical themes. The quality of the identified studies was assessed and the relative contribution of each paper was checked to ensure individual studies did not dominate in any theme. Results Eighteen relevant papers were identified which examined the views of researchers and clinicians in 10 clinical specialties. Five main themes emerged: building a research community, securing resources, the nature of research, professional identities and recruitment strategies. The views of researchers and clinicians were similar, although the role of ‘researcher’ was inconsistently defined. Conclusions The general experience of recruiting participants to clinical research was one of competition and compromise. Competition arose over funding, staffing and participants, and between clinical and research responsibilities. Compromise was needed to create study designs that were acceptable to patients, clinicians and researchers. Forging relationships between clinical and research teams featured extensively, however the involvement of patients and the public within the research community was rarely discussed.
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Affiliation(s)
- Lisa Newington
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, SE1 9RT, UK
| | - Alison Metcalfe
- Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, SE1 8WA, UK
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Communication skills training for breast cancer teams talking about trials. Breast 2013; 23:193-7. [PMID: 24342374 DOI: 10.1016/j.breast.2013.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/18/2013] [Accepted: 11/24/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES We modified an educational intervention developed to improve communication about clinical trials and enhance multidisciplinary team (MDT) working for specialist breast cancer MDTs. We assessed the effect of one day MDT training on team members' awareness & clarity about trials in their portfolio, and individuals' confidence & communication about clinical trials. MATERIALS AND METHODS Six MDTs in England participated between May 2012 and January 2013. Teams identified a breast trial from their portfolio that was about to start or one for which recruitment was proving difficult. Participants completed questionnaires identifying their roles and awareness of trial activity. The interactive workshop contained several generic elements: including PPT presentations, relevant exercises, and practical sessions but were also customised to fit the individual MDT requirements. Participants completed post-course questionnaires and the team leaders completed a 6-month review. RESULTS Eighty healthcare professionals participated. There were significant positive changes (P < 0.001) post-workshop for all 15 key areas probed concerning awareness and clarity about the trial(s) discussed during the training intervention. Six month questionnaire data revealed 5/6 teams had greater awareness of actual roles played by their colleagues and that more team members were willing and able to discuss trial(s) with patients. Additionally, 5/6 team leaders said that dynamics had changed for the better and enthusiasm for trials improved. CONCLUSION Workshops focussed on clinical trials can be conducted in one day and produce improvements in team awareness, knowledge of teams' trials portfolios and communication skills.
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Somkin CP, Ackerson L, Husson G, Gomez V, Kolevska T, Goldstein D, Fehrenbacher L. Effect of medical oncologists' attitudes on accrual to clinical trials in a community setting. J Oncol Pract 2013; 9:e275-83. [PMID: 24151327 PMCID: PMC5706122 DOI: 10.1200/jop.2013.001120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncology clinical trials (OCTs) are crucial in evaluating new cancer treatments, but only 2% to 3% of US adult patients with cancer enter OCTs. This study assessed barriers to participation in clinical trials among oncologists in a large integrated health care delivery system with an active clinical trials program. Although many studies have identified major physician barriers to enrollment, few have examined how these barriers affect actual trial accrual. METHODS Using information from a mailed survey, we examined the effect of oncologists' attitudes, beliefs, experiences, sociodemographic factors, and practice characteristics on clinical trial accrual in the 2 years following the survey. We identified relationships between these variables and subsequent clinical trial accrual using correlations and mixed effects models. RESULTS A construct combining questions that assessed oncologist attitudes, beliefs, and experiences substantially influenced OCT enrollment (r = .51; P < .0001). This construct included awareness of open clinical trials and specific eligible patients, as well as the practice of initiating a discussion about OCTs with most eligible patients. This broad concept of awareness had the greatest correlation with enrollment and mediated the effect on enrollment of other values and beliefs, such as welcoming a patient's initiation of a trial discussion and valuing the support of research nurses and coordinators. CONCLUSION Even in a health care setting with an active clinical trials program, substantial research personnel, infrastructure support, and widespread access to trials among oncologists and patients, oncologists' participation remains quite variable. Oncologist values, beliefs, and awareness of clinical trials play an important role in OCT accrual.
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Affiliation(s)
- Carol P. Somkin
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Lynn Ackerson
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Gail Husson
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Vicky Gomez
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Tatjana Kolevska
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Desiree Goldstein
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
| | - Louis Fehrenbacher
- Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA
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Shaw R, Mehanna H. Surgical trials in head & neck cancer - are you serious? Oral Oncol 2013; 49:843-844. [PMID: 23816607 DOI: 10.1016/j.oraloncology.2013.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Richard Shaw
- Mersey Head & Neck Oncology Research Group, Liverpool CR-UK Centre, Department of Molecular & Clinical Cancer Medicine, University of Liverpool, 5th Floor Duncan Bldg., Daulby St., Liverpool L69 3GA, UK.
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Jenkins V, Farewell D, Farewell V, Batt L, Wagstaff J, Langridge C, Fallowfield L. Teams Talking Trials: Results of an RCT to improve the communication of cancer teams about treatment trials. Contemp Clin Trials 2013; 35:43-51. [DOI: 10.1016/j.cct.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 10/27/2022]
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Jenkins V, Farewell V, Farewell D, Darmanin J, Wagstaff J, Langridge C, Fallowfield L. Drivers and barriers to patient participation in RCTs. Br J Cancer 2013; 108:1402-7. [PMID: 23511558 PMCID: PMC3629425 DOI: 10.1038/bjc.2013.113] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recruitment of patients into randomised clinical trials (RCTs) is essential for treatment evaluation. Appreciation of the barriers and drivers towards participation is important for trial design, communication and information provision. METHOD As part of an intervention to facilitate effective multidisciplinary team communication about RCTs, cancer patients completed two study-specific questionnaires following trial discussions. One questionnaire examined reasons why patients accepted or declined trial entry, the other perceptions about their health-care professionals' (HCPs) information giving. RESULTS Questionnaires were completed by 74% (358/486) of patients approached; of these 81% (291/358) had joined an RCT, 16% (56/358) had declined and 3% (11/358) were undecided. Trial participation status of the 128 patients not returning questionnaires is unknown. Trial acceptance was not dependent on disease stage, tumour type, sex or age. Satisfaction with trial information and HCPs' communication was generally very good, irrespective of participation decisions. The primary reason given for trial acceptance was altruism (40%; 110/275), and for declining, trust in the doctor (28%; 12/43). Decliners preferred doctors to choose their treatment rather than be randomised (54% vs 39%; P<0.027). Acceptors were more likely to perceive doctors as wanting them to join trials (54% vs 30%; P<0.001). Trial type, that is, standard treatment vs novel or different durations of treatment, also influenced acceptance rates. CONCLUSION The drivers and barriers to trial participation are partly related to trial design. Unease about randomisation and impact of duration on treatment efficacy are barriers for some. Altruism and HCPs' perceived attitudes are powerful influencing factors.
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Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9QG, UK.
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Chen L, Grant J, Cheung WY, Kennecke HF. Screening intervention to identify eligible patients and improve accrual to phase II-IV oncology clinical trials. J Oncol Pract 2013; 9:e174-81. [PMID: 23942936 DOI: 10.1200/jop.2012.000763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low enrolment rates in clinical trials present a barrier to the development of novel cancer therapies. Currently, only 3% of patients with cancer participate, and many studies fail to achieve necessary enrolment. The objective of this study was to evaluate whether a screening intervention to identify potentially eligible patients (PEPs) would increase accrual rates. PATIENTS AND METHODS Over a 4-month intervention period, PEPs for 21 phase II-IV breast, gastrointestinal, genitourinary, gynecology, and lung cancer trials were identified by a screening coordinator. This individual reviewed the electronic medical records of patients attending outpatient clinics and flagged PEPs for 10 medical oncologists at the BC Cancer Agency. Patients who were already documented to be trial eligible by physicians were not flagged. Oncologists were surveyed regarding the helpfulness and accuracy of the intervention. RESULTS During the intervention period, 73 patients were enrolled, compared with 61 patients enrolled in the 4 months prior and 51 patients in the 4 months after. A total of 2,098 charts were reviewed, and 120 PEPs were identified during the intervention period, resulting in 19 PEPs who enrolled and four PEPs who declined a clinical trial. Relative accrual rates adjusted for oncologist appointments were 0.85 (P = .15) before and 0.70 (P < .005) after, relative to the intervention period. Oncologist-returned surveys indicated that 67% of flags were helpful, and 70% were accurate. CONCLUSIONS In this study, manually screening patient records increased enrolment to specific clinical trials. A screening intervention process, involving a dedicated screening coordinator, should be considered to improve clinical trial accrual.
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Affiliation(s)
- Leo Chen
- University of British Columbia; and British Columbia Cancer Agency-Vancouver Center, Vancouver, British Columbia, Canada
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Kaur G, Hutchison I, Mehanna H, Williamson P, Shaw R, Tudur Smith C. Barriers to recruitment for surgical trials in head and neck oncology: a survey of trial investigators. BMJ Open 2013; 3:bmjopen-2013-002625. [PMID: 23585392 PMCID: PMC3641444 DOI: 10.1136/bmjopen-2013-002625] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Many randomised trials in surgery suffer from recruitment rates that lag behind projected targets. We aim to identify perceived barriers to recruitment among these pioneering trials in the field of head and neck cancer surgery. DESIGN Recruiting centres to all three trials (Selective Elective Neck Dissection (SEND), Positron Emission Tomography (PET)-Neck and Hyperbaric Oxygen in the Prevention of Osteoradionecrosis (HOPON)) were contacted by email by the chief investigators. Responders were asked to complete a web-based survey in order to identify the barriers to recruitment in their centre and grade each by severity. SETTING Secondary care: 44 head and neck oncology regional referral centres. PARTICIPANTS Analysis was based on 85 responses evenly distributed between the three trials. RESULTS The most commonly identified perceived barriers to recruitment (more than 50% of responders identified the item as a barrier in all the three trials) in the order of frequency were: patients consent refusal because of expressed treatment preference, patients consent refusal owing to aversion to randomisation, excess complexity/amount of information provided to patients and lack of time in clinic to accommodate research. The most severely rated of these problems was consent refusal because of the expressed treatment preference and lack of time in the clinic. CONCLUSIONS Our findings confirm others' work in surgery that the most significant barrier to trial recruitment in head and neck cancer surgery is the patient's preference for one arm of the trial. It may be that additional training for those taking consent may be helpful in this regard. It is also important to adequately resource busy surgical clinics to support clinical trial recruitment.
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Affiliation(s)
- Geetinder Kaur
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Iain Hutchison
- Department of Oral and Maxillofacial Surgery, St Bartholomew's & The Royal London, London, UK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Paula Williamson
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Richard Shaw
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Ramirez AG, Chalela P, Suarez L, Muñoz E, Pollock BH, Weitman SD, Gallion KJ. Early Phase Clinical Trials: Referral Barriers and Promoters among Physicians. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2012; 2:1000173. [PMID: 24073358 PMCID: PMC3782313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Physician referral is among the most effective means of recruiting patients into cancer clinical trials. Therefore, to increase minority representation in early-phase clinical trials (EPCTs), specifically accrual of Latinos, it is first necessary to examine physicians' attitudes and practices regarding these studies and factors that influence physicians' referral decisions. METHODS This study surveyed oncologists (N=111) from a Texas Medical Association mailing list to examine barriers and promoting factors associated with physician referral of patients to EPCTs and identify areas for intervention to increase accrual of Latinos and other minorities into clinical research. Exploratory factor analysis was conducted to identify underlying dimensions, and significant factors that promote or deter physicians from referring patients to EPCTs were assessed through multiple logistic regression. RESULTS Burden of the clinical trial process was the only significant dimension associated with referring patients to EPCTs. Physicians who agreed with this set of logistical barriers-such as diverting time and resources away from their practice-were less likely to refer patients than physicians with opposing opinions (OR= 0.28, 95% CI= 0.08-0.94). CONCLUSION This study, one of the first to identify physician barriers for referring patients to EPCTs in Texas, highlights potential focal areas for physician and community-based education and communication to promote clinical trial opportunities among both minority and non-minority patients. Given that Texas physicians deal with a large proportion of Latino patients, such efforts could also address ethnic disparities in clinical trial participation, which will become increasingly important as the Latino population continues to grow.
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Affiliation(s)
- Amelie G Ramirez
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr. Suite 1000 San Antonio, TX 78229
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Langbecker D, Janda M, Yates P. Health professionals' perspectives on information provision for patients with brain tumours and their families. Eur J Cancer Care (Engl) 2012; 22:179-87. [PMID: 22989208 DOI: 10.1111/ecc.12011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A significant number of patients diagnosed with primary brain tumours report unmet information needs. Using concept mapping methodology, this study aimed to identify strategies for improving information provision, and to describe factors that health professionals understood to influence their provision of information to patients with brain tumours and their families. Concept mapping is a mixed-methods approach that uses statistical methods to represent participants' perceived relationships between elements as conceptual maps. These maps, and results of associated data collection and analyses, are used to extract concepts involved in information provision to these patients. Thirty health professionals working across a range of neuro-oncology roles and settings participated in the concept mapping process. Participants rated a care coordinator as the most important strategy for improving brain tumour care, with psychological support as a whole rated as the most important element of care. Five major themes were identified as facilitating information provision: health professionals' communication skills, style and attitudes; patients' needs and preferences; perceptions of patients' need for protection and initiative; rapport and continuity between patients and health professionals; and the nature of the healthcare system. Overall, health professionals conceptualised information provision as 'individualised', dependent on these interconnected personal and environmental factors.
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Affiliation(s)
- D Langbecker
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
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Wüsthoff LE, Waal H, Gråwe RW. When research meets reality-lessons learned from a pragmatic multisite group-randomized clinical trial on psychosocial interventions in the psychiatric and addiction field. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2012; 6:95-106. [PMID: 22933843 PMCID: PMC3427035 DOI: 10.4137/sart.s9245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Research on treatments for patients with co-occurring psychiatric and substance use disorders is of core importance and at the same time highly challenging as it includes patients that are normally excluded from clinical studies. Such research may require methodological adaptations which in turn create new challenges. However, the challenges that arise in such studies are insufficiently discussed in the literature. The aim of this methodology paper is, firstly, to discuss the methodological adaptations that may be required in such research; secondly, to describe how such adaptations created new challenges in a group-randomized clinical trial on Integrated Treatment amongst patients with co-occurring psychiatric and substance use disorders. We also discuss how these challenges might be understood and highlight lessons for future research in this field. TRIAL REGISTRATION NCT00447733.
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Affiliation(s)
- Linda E Wüsthoff
- Norwegian Center for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Parreco LK, DeJoice RW, Massett HA, Padberg RM, Thakkar SS. Power of an effective clinical conversation: improving accrual onto clinical trials. J Oncol Pract 2012; 8:282-6. [PMID: 23277764 DOI: 10.1200/jop.2011.000478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2011] [Indexed: 11/20/2022] Open
Abstract
The National Cancer Institute (NCI) is actively transforming clinical trials to revitalize the clinical trials system and improve patient accrual. For more than 30 years, NCI has provided information and communication resources about cancer clinical trials. The Institute supports a clinical trials Web site (www.cancer.gov/clinicaltrials) that receives nearly a half million page views a month. In addition, NCI's Cancer Information Service (800-4-CANCER, chat and e-mail) responds to 1,750 clinical trial inquiries every month. Although these numbers suggest that a high volume of clinical trial information is being exchanged between NCI, the public, and providers, most patients decide whether to participate in clinical trials during the patient-provider interaction.
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Al-Refaie WB, Vickers SM. Are cancer trials valid and useful for the general surgeon and surgical oncologist? Adv Surg 2012; 46:269-281. [PMID: 22873045 DOI: 10.1016/j.yasu.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cancer trials represent a rigorous and clear approach to testing whether an intervention or treatment will alter the outcomes of individuals with cancer in an experimental manner that is beyond the level of observational studies. As such, they remain useful and valid to the day-to-day practice of general surgeons and surgical oncologists. However, the shortcomings of current cancer clinical trials need to be recognized, especially when less than 1% of adults persons with cancer participate in cancer clinical trials, thus leaving the ability to generalize these trials to patients and their surgeons in the real-world setting an open question. Moving forward, physicians, payers, professional societies, advocates, the NCI, and other stakeholders need to develop broader cancer trials to benefit the millions of patients with cancer in the United States.
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Affiliation(s)
- Waddah B Al-Refaie
- Department of Surgery, Surgical Outcomes Research Center, University of Minnesota and Minneapolis VAMC, MMC# 195, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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