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Hughes-Morley A, Hann M, Fraser C, Meade O, Lovell K, Young B, Roberts C, Cree L, More D, O’Leary N, Callaghan P, Waheed W, Bower P. The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial. Trials 2016; 17:586. [PMID: 27931252 PMCID: PMC5146878 DOI: 10.1186/s13063-016-1718-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants. METHODS This is a cluster trial, embedded within a host trial ('EQUIP') recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation. RESULTS Thirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes. CONCLUSION To our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research. TRIAL REGISTRATION NUMBERS ISRCTN, ISRCTN16488358 . Registered on 14 May 2014. Study Within A Trial, SWAT-26 . Registered on 21 January 2016.
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Affiliation(s)
- Adwoa Hughes-Morley
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Claire Fraser
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Oonagh Meade
- School of Health Sciences, Queen’s Medical Centre, The University of Nottingham, Nottingham, NG7 2HA UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Chris Roberts
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Donna More
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Neil O’Leary
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Republic of Ireland
| | - Patrick Callaghan
- School of Health Sciences and Institute of Mental Health, The University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU UK
| | - Waquas Waheed
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
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Rose D, Russo J, Wykes T. Taking part in a pharmacogenetic clinical trial: assessment of trial participants understanding of information disclosed during the informed consent process. BMC Med Ethics 2013; 14:34. [PMID: 24025622 PMCID: PMC3847084 DOI: 10.1186/1472-6939-14-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/20/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study is the first to examine the understandings that participants have of the consent process in a pharmacogenetic trial of anti-depressant medication. METHODS This was a qualitative cross sectional study. There were 76 participants residing in London, Mannheim, Arhuus and Poznan. RESULTS Only one quarter of participants (none in Poznan) could articulate the concept of pharmacogenetics. Heritability and testing medication were also given as the purpose of the trial. Most participants had not appreciated harms that could derive from the trial. Even when shown the consent sheet, participants were confused about DNA profiling. There was evidence that participants appreciated weekly contact with researchers. Most said they would participate in a trial again but would like choice over the intervention they were assigned to. CONCLUSION Participants in this study showed a poor level of informed consent. Although this is not the first time this argument has been made, it is in the case of a pharmacogenetic trial. Further work should investigate the associations between extraneous factors such as information and social support on beneficial or untoward outcomes of antidepressant treatment.
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Affiliation(s)
- Diana Rose
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
| | - Jasna Russo
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
| | - Til Wykes
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
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Serretti A, Kato M, Kennedy JL. Pharmacogenetic studies in depression: a proposal for methodologic guidelines. THE PHARMACOGENOMICS JOURNAL 2007; 8:90-100. [PMID: 17684474 DOI: 10.1038/sj.tpj.6500477] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pharmacogenetic studies in mood disorders are rapidly proliferating after the initial reports linking gene variants to treatment outcomes. However, a considerable range of methodologies has been used, making it difficult to compare results across studies and limiting the representativeness of findings. Specification of sampling source (inpatients vs outpatients, primary vs tertiary settings), standardization of diagnostic systems and treatments, adequate monitoring of compliance through plasma levels, sufficient length of observation (at least 6 weeks for acute antidepressant treatments, though 3-6 months are preferable), the use of a range of response criteria and the inclusion of possible environmental confounding variables (life events, social support, temperament) are all potentially important issues when planning pharmacogenetic studies. We reviewed the state-of-the-art methodology and suggested possible guideline for future studies.
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Affiliation(s)
- A Serretti
- Institute of Psychiatry, University of Bologna, Bologna, Italy.
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