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Haviari S, Mentré F. Distributive randomization: a pragmatic fractional factorial design to screen or evaluate multiple simultaneous interventions in a clinical trial. BMC Med Res Methodol 2024; 24:64. [PMID: 38468221 DOI: 10.1186/s12874-024-02191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND In some medical indications, numerous interventions have a weak presumption of efficacy, but a good track record or presumption of safety. This makes it feasible to evaluate them simultaneously. This study evaluates a pragmatic fractional factorial trial design that randomly allocates a pre-specified number of interventions to each participant, and statistically tests main intervention effects. We compare it to factorial trials, parallel-arm trials and multiple head-to-head trials, and derive some good practices for its design and analysis. METHODS We simulated various scenarios involving 4 to 20 candidate interventions among which 2 to 8 could be simultaneously allocated. A binary outcome was assumed. One or two interventions were assumed effective, with various interactions (positive, negative, none). Efficient combinatorics algorithms were created. Sample sizes and power were obtained by simulations in which the statistical test was either difference of proportions or multivariate logistic regression Wald test with or without interaction terms for adjustment, with Bonferroni multiplicity-adjusted alpha risk for both. Native R code is provided without need for compiling or packages. RESULTS Distributive trials reduce sample sizes 2- to sevenfold compared to parallel arm trials, and increase them 1- to twofold compared to factorial trials, mostly when fewer allocations than for the factorial design are possible. An unexpectedly effective intervention causes small decreases in power (< 10%) if its effect is additive, but large decreases (possibly down to 0) if not, as for factorial designs. These large decreases are prevented by using interaction terms to adjust the analysis, but these additional estimands have a sample size cost and are better pre-specified. The issue can also be managed by adding a true control arm without any intervention. CONCLUSION Distributive randomization is a viable design for mass parallel evaluation of interventions in constrained trial populations. It should be introduced first in clinical settings where many undercharacterized interventions are potentially available, such as disease prevention strategies, digital behavioral interventions, dietary supplements for chronic conditions, or emerging diseases. Pre-trial simulations are recommended, for which tools are provided.
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Affiliation(s)
- Skerdi Haviari
- Université Paris Cité, Inserm, IAME, Paris, 75018, France.
- Département Epidémiologie Biostatistiques Et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France.
| | - France Mentré
- Université Paris Cité, Inserm, IAME, Paris, 75018, France
- Département Epidémiologie Biostatistiques Et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France
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Wu C, Wang N, Wang Q, Wang C, Wei Z, Wu Z, Yu S, Jiang X. Participants' understanding of informed consent in clinical trials: A systematic review and updated meta-analysis. PLoS One 2024; 19:e0295784. [PMID: 38166097 PMCID: PMC10760836 DOI: 10.1371/journal.pone.0295784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
Obtaining written informed consent from participants before enrolment in a study is essential. A previous study showed that only 50% of the participants in clinical trials understood the components of informed consent, and the methods of participants' understanding of informed consent were controversial. This updated meta-analysis aimed to estimate the proportion of participants in clinical trials who understand the different informed consent components. PubMed, EMBASE, the Cochrane Library, and Scopus were searched till April 2023. Therapeutic misconception, ability to name one risk, knowing that treatments were being compared, and understanding the nature of the study, the purpose of the study, the risks and side-effects, the direct benefits, placebo, randomization, voluntariness, freedom to withdraw, the availability of alternative treatment if withdrawn from the trial, confidentiality, compensation, or comprehension were evaluated. This meta-analysis included 117 studies (155 datasets; 22,118 participants). The understanding of the risks and side-effects was investigated in the largest number of studies (n = 100), whereas comparehension was investigated in the smallest number (n = 11). The highest proportions were 97.5%(95% confidence interval (CI): 97.1-97.9) for confidentiality, 95.9% (95% confidence interval (CI): 95.4-96.4) for compensation, 91.4% (95% CI: 90.7-92.1) for the nature of study, 68.1% (95% CI: 51.6-84.6) for knowing that treatments were being compared, and 67.3% (95% CI: 56.6-78) for voluntary nature of participants. The smallest proportions were the concept of placebo (4.8%, 95%CI: 4.4-5.2) and randomization(39.4%, 95%CI: 38.3-40.4). Our findings suggested that most participants understood the fundamental components of informed consent (study confidentiality, nature, compensation, voluntariness, and freedom to withdraw). The understanding of other components, such as placebo and randomization was less satisfactory.
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Affiliation(s)
- Chengai Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Qianqian Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhenjie Wei
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhimin Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Shunan Yu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xieyuan Jiang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
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Odedina FT, Wieland ML, Barbel-Johnson K, Crook JM. Community Engagement Strategies for Underrepresented Racial and Ethnic Populations. Mayo Clin Proc 2024; 99:159-171. [PMID: 38176825 DOI: 10.1016/j.mayocp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 01/06/2024]
Abstract
The representation of racial and ethnic minority populations in clinical trials continues to be a challenge despite mandates, good intentions, and concerted efforts by funding agencies, regulatory bodies, and researchers to close the clinical trials gap. A lack of diversity in research results in both continued disparities and poorer health outcomes. It is thus imperative that investigators understand and effectively address the challenges of clinical trials participation by underrepresented populations. In this paper, we expound on best practices for participatory research by clearly defining the community, highlighting the importance of proper identification and engagement of strong community partners, and exploring patient- and provider-level barriers and facilitators that require consideration. A clearer understanding of the balance of power between researchers and community partners is needed for any approach that addresses clinical trials representation. Unintended biases in study design and methods may continue to prevent racial and ethnic minority participants from taking part, and significant organizational changes are necessary for efficient and transparent relationships. Comprehensive community engagement in research includes dissemination of clinical trial results within and in partnership with community partners. Through careful deliberation and honest reflection, investigators, institutions, and community partners can develop the tailored blueprints of research collaborations essential for true equity in clinical trials.
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Affiliation(s)
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
| | | | - Jennifer M Crook
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL
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Heyrman B, Meers S, Van De Velde A, Anguille S. Combined Results of Two Cross-Sectional Surveys on the Participation in Clinical Trials and the e-Consent Procedure in the Landscape of Haematology. Clin Pract 2023; 13:1520-1531. [PMID: 38131682 PMCID: PMC10742482 DOI: 10.3390/clinpract13060133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Despite the motivation of oncology patients to take part in clinical trials, only a minority of them are enrolled in clinical trials. Implementation of new practical procedures can become a barrier that withholds patients from participating in clinical trials. Treating physicians are crucial in augmenting trial accrual. The drivers that promote physicians to allocate patients for clinical trials need further assessment. We conducted two separate cross-sectional surveys, addressing patients with a haematological disease in one survey and haematologists in another survey. The patient survey was filled out by 420 patients. Significant relationships between the willingness to participate in a trial and trial knowledge (p < 0.001) and between doctor-patient relationship and participation willingness (p = 0.007) were noted. Patients above 60 years were less willing to use an electronic consent procedure vs. patients younger than 60 (p < 0.001). The physician questionnaire was completed by 42 participants of whom most (83%) were active in and (94%) motivated for clinical trials. Apart from the patient benefit and scientific interest, prestige was an equal motivator closely followed by financial remunerations. First goal was not to harm the patient. Our study confirms the high willingness of patients for trial participation and the need to rethink the structure of trial organisation. The e-consent procedure is not the method preferred by most patients above 60 years old.
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Affiliation(s)
- Bert Heyrman
- Ziekenhuis Netwerk Antwerpen, Department of Haematology, 2020 Antwerp, Belgium
| | - Stef Meers
- Algemeen Ziekenhuis KLINA, Department of Haematology, 2930 Brasschaat, Belgium
| | - Ann Van De Velde
- Department of Haematology, University Hospital Antwerp, 2650 Edegem, Belgium
| | - Sébastien Anguille
- Department of Haematology, University Hospital Antwerp, 2650 Edegem, Belgium
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Wheelwright S, Matthews L, Jenkins V, May S, Rea D, Fairbrother P, Gaunt C, Young J, Pirrie S, Wallis MG, Fallowfield L. Recruiting women with ductal carcinoma in situ to a randomised controlled trial: lessons from the LORIS study. Trials 2023; 24:670. [PMID: 37838682 PMCID: PMC10576350 DOI: 10.1186/s13063-023-07703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND The LOw RISk DCIS (LORIS) study was set up to compare conventional surgical treatment with active monitoring in women with ductal carcinoma in situ (DCIS). Recruitment to trials with a surveillance arm is known to be challenging, so strategies to maximise patient recruitment, aimed at both patients and recruiting centres, were implemented. METHODS Women aged ≥ 46 years with a histologically confirmed diagnosis of non-high-grade DCIS were eligible for 1:1 randomisation to either surgery or active monitoring. Prior to randomisation, all eligible women were invited to complete: (1) the Clinical Trials Questionnaire (CTQ) examining reasons for or against participation, and (2) interviews exploring in depth opinions about the study information sheets and film. Women agreeing to randomisation completed validated questionnaires assessing health status, physical and mental health, and anxiety levels. Hospital site staff were invited to communication workshops and refresher site initiation visits to support recruitment. Their perspectives on LORIS recruitment were collected via surveys and interviews. RESULTS Eighty percent (181/227) of eligible women agreed to be randomised. Over 40% of participants had high anxiety levels at baseline. On the CTQ, the most frequent most important reasons for accepting randomisation were altruism and belief that the trial offered the best treatment, whilst worries about randomisation and the influences of others were the most frequent most important reasons for declining. Most women found the study information provided clear and useful. Communication workshops for site staff improved knowledge and confidence but only about half said they themselves would join LORIS if eligible. The most common recruitment barriers identified by staff were low numbers of eligible patients and patient preference. CONCLUSIONS Recruitment to LORIS was challenging despite strategies aimed at both patients and site staff. Ensuring that recruiting staff support the study could improve recruitment in similar future trials. TRIAL REGISTRATION ISRCTN27544579, prospectively registered on 22 May 2014.
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Affiliation(s)
- Sally Wheelwright
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RX, UK.
| | - Lucy Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RX, UK
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Claire Gaunt
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jennie Young
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RX, UK
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Terzolo M, Fassnacht M, Perotti P, Libé R, Kastelan D, Lacroix A, Arlt W, Haak HR, Loli P, Decoudier B, Lasolle H, Quinkler M, Haissaguerre M, Chabre O, Caron P, Stigliano A, Giordano R, Zatelli MC, Bancos I, Fragoso MCBV, Canu L, Luconi M, Puglisi S, Basile V, Reimondo G, Kroiss M, Megerle F, Hahner S, Kimpel O, Dusek T, Nölting S, Bourdeau I, Chortis V, Ettaieb MH, Cosentini D, Grisanti S, Baudin E, Berchialla P, Bovis F, Sormani MP, Bruzzi P, Beuschlein F, Bertherat J, Berruti A. Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational study. Lancet Diabetes Endocrinol 2023; 11:720-730. [PMID: 37619579 PMCID: PMC10522778 DOI: 10.1016/s2213-8587(23)00193-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Adjuvant treatment with mitotane is commonly used after resection of adrenocortical carcinoma; however, treatment remains controversial, particularly if risk of recurrence is not high. We aimed to assess the efficacy and safety of adjuvant mitotane compared with surveillance alone following complete tumour resection in patients with adrenocortical carcinoma considered to be at low to intermediate risk of recurrence. METHODS ADIUVO was a multicentre, open-label, parallel, randomised, phase 3 trial done in 23 centres across seven countries. Patients aged 18 years or older with adrenocortical carcinoma and low to intermediate risk of recurrence (R0, stage I-III, and Ki67 ≤10%) were randomly assigned to adjuvant oral mitotane two or three times daily (the dose was adjusted by the local investigator with the target of reaching and maintaining plasma mitotane concentrations of 14-20 mg/L) for 2 years or surveillance alone. All consecutive patients at 14 study centres fulfilling the eligibility criteria of the ADIUVO trial who refused randomisation and agreed on data collection via the European Network for the Study of Adrenal Tumors adrenocortical carcinoma registry were included prospectively in the ADIUVO Observational study. The primary endpoint was recurrence-free survival, defined as the time from randomisation to the first radiological evidence of recurrence or death from any cause (whichever occurred first), assessed in all randomly assigned patients by intention to treat. Overall survival, defined as time from the date of randomisation to the date of death from any cause, was a secondary endpoint analysed by intention to treat in all randomly assigned patients. Safety was assessed in all patients who adhered to the assigned regimen, which was defined by taking at least one tablet of mitotane in the mitotane group and no mitotane at all in the surveillance group. The ADIUVO trial is registered with ClinicalTrials.gov, NCT00777244, and is now complete. FINDINGS Between Oct 23, 2008, and Dec 27, 2018, 45 patients were randomly assigned to mitotane and 46 to surveillance alone. Because the study was discontinued prematurely, 5-year recurrence-free and overall survival are reported instead of recurrence-free and overall survival as defined in the protocol. 5-year recurrence-free survival was 79% (95% CI 67-94) in the mitotane group and 75% (63-90) in the surveillance group (hazard ratio 0·74 [95% CI 0·30-1·85]). Two people in the mitotane group and five people in the surveillance group died, and 5-year overall survival was not significantly different (95% [95% CI 89-100] in the mitotane group and 86% [74-100] in the surveillance group). All 42 patients who received mitotane had adverse events, and eight (19%) discontinued treatment. There were no grade 4 adverse events or treatment-related deaths. INTERPRETATION Adjuvant mitotane might not be indicated in patients with low-grade, localised adrenocortical carcinoma considering the relatively good prognosis of these patients, and no significant improvement in recurrence-free survival and treatment-associated toxicity in the mitotane group. However, the study was discontinued prematurely due to slow recruitment and cannot rule out an efficacy of treatment. FUNDING AIFA, ENSAT Cancer Health F2-2010-259735 programme, Deutsche Forschungsgemeinschaft, Cancer Research UK, and the French Ministry of Health.
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Affiliation(s)
- Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Rossella Libé
- Rare Cancer Network COMETE Cancer, Hôpital Cochin, Paris, France
| | - Darko Kastelan
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - André Lacroix
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; MRC London Institute of Medical Sciences and Faculty of Medicine, Imperial College London, London, UK
| | - Harm Reinout Haak
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, Netherlands; CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, and Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Paola Loli
- Division of Endocrinology, Niguarda Cà Granda Hospital, Milan, Italy
| | - Bénédicte Decoudier
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie-Diabètologie-Nutrition, Reims, France
| | - Helene Lasolle
- Federation d'Endocrinologie, Hospices Civils de Lyon and University de Lyon, Lyon, France
| | | | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, France
| | - Olivier Chabre
- University Grenoble Alpes, Service d'Endocrinologie CHU Grenoble Alpes, Unité Mixte de Recherche INSERM-CEA-UGA UMR1036 38000 Grenoble Alpes, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Giordano
- Division of Endocrinology, Diabetology and Metabolism, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Cancer do Estado de São Paulo-ICESP, São Paulo, Brazil
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Otilia Kimpel
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Tina Dusek
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - Svenja Nölting
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Bourdeau
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Deborah Cosentini
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Eric Baudin
- Endocrine Oncology Gustave Roussy, Villejuif, France
| | - Paola Berchialla
- Statistical Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paolo Bruzzi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Felix Beuschlein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Service d'Endocrinologie, Hopital Cochin, APHP, Paris, France
| | - Alfredo Berruti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
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Reincke M. Good news for patients with adrenocortical carcinoma from the ADIUVO trial. Lancet Diabetes Endocrinol 2023; 11:708-709. [PMID: 37619580 DOI: 10.1016/s2213-8587(23)00231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 München, Germany.
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Pinho-Gomes AC, Carcel C, Woodward M, Hockham C. Women's representation in clinical trials of patients with chronic kidney disease. Clin Kidney J 2023; 16:1457-1464. [PMID: 37664564 PMCID: PMC10469102 DOI: 10.1093/ckj/sfad018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 09/05/2023] Open
Abstract
Background Sex and gender differences in chronic kidney disease (CKD), including epidemiology and response to treatment, remain poorly understood. This study aimed to investigate how women are represented in CKD clinical trials and whether sex- and gender-disaggregated outcomes were reported. Methods Clinical trials on CKD were identified from ClinicalTrials.gov. Randomised, phase 3/4 trials with ≥100 participants were selected to quantify women's representation among participants by computing the participation:prevalence ratio (PPR) and investigating whether sex-disaggregated analyses had been performed. Results In total, 192 CKD trials registered on ClinicalTrials.gov and published between 1995 and 2022 were included. Overall, women accounted for 66 875 (45%) of the 147 136 participants. Women's participation in clinical trials was lower than their representation in the underlying CKD population globally (55%). The PPR was 0.75 (95% confidence interval 0.72-0.78), with no significant variation irrespective of mean age, CKD stage, dialysis, location, type of intervention or funding agency. A total of 39 (20%) trials reported sex-disaggregated efficacy outcomes and none reported sex-disaggregated safety outcomes. Conclusion Women's participation in CKD clinical trials was lower than their representation in the underlying CKD population. Sex-disaggregated efficacy and safety outcomes were rarely reported. Improving women's enrolment into clinical trials is crucial to enable sex- and gender-disaggregated analysis and thus identify potential differences in treatment response between women and men.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, Imperial College London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, UK
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Almutairi A, Alqubaishi FA, Alsolm EA, Binowayn A, Almohammad R, Wani T, Ababtain A, Alkadi U, Alrashed MM, Althagafi M, Abu-Safieh L. Factors that influence a patient's decision to engage in genetic research. Front Public Health 2023; 11:865786. [PMID: 37283985 PMCID: PMC10239877 DOI: 10.3389/fpubh.2023.865786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/11/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction The most challenging step in clinical research studies is patient recruitment. Many research studies do not reach their targets because of participant rejection. The purpose of this study was to assess patient as well as the community knowledge, motivation, and barriers to participate in genetic research. Methods A cross-section study was conducted between September 2018 and February 2020 using face-to-face interviews with candidate patients from outpatient clinics at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Additionally, an online survey was conducted to assess the community's knowledge, motivation and barriers to participate in genetic research studies. Results In total, 470 patients were interviewed for this study, with 341 being successfully recruited for the face to face interview, and the other patients being refused owing to time constraints. The majority percentage of the respondents were females. The respondents' mean age was 30, and 52.6% reported having a college degree. The survey results from 388 participants illustrated that around 90% of the participants, participated voluntarily due to a good understanding of genetics studies. The majority held positive attitudes toward being part of genetic research, which exceeded the reported motivation score of >75%. The survey indicated that >90% of individuals were willing to participate to acquire therapeutic benefits or to receive continued aftercare. However, 54.6% of survey participants were worried about the side effects and the risks involved in genetic testing. A higher proportion (71.4%) of respondents reported that lack of knowledge about genetic research was one of the barriers to rejecting participation. Conclusion Respondents reported relatively high motivation and knowledge for participation in genetic research. However, study participants reported "do not know enough about genetic research" and "lack of time during clinic visit" as a barrier for participation in genetic research.
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Affiliation(s)
- Amal Almutairi
- King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | | | - Ebtehal A. Alsolm
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | | | - Rania Almohammad
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Tariq Wani
- Research Services, Department of Biostatistics, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aljohara Ababtain
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Udai Alkadi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - May M. Alrashed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Malak Althagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Leen Abu-Safieh
- Bioinformatics and Computational Biology Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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10
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Ramsay G, Haime Z, Crellin NE, Stansfeld JL, Priebe S, Long M, Moncrieff J. Recruitment to a trial of antipsychotic reduction: impact of an acceptability study. BMC Med Res Methodol 2023; 23:78. [PMID: 36991350 PMCID: PMC10053425 DOI: 10.1186/s12874-023-01881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Pre-trial acceptability studies may boost recruitment, especially in trials comparing distinctly different interventions. We evaluated the impact of an acceptability study on recruitment to a randomised trial of antipsychotic reduction versus maintenance treatment and explored demographic and clinical predictors of subsequent enrolment. METHODS Participants with a diagnosis of a schizophrenia spectrum disorder who were taking antipsychotic medication were interviewed about their views of taking part in a future trial. RESULTS In a sample of 210 participants, 151 (71.9%) expressed an interest in taking part in the future trial, 16 (7.6%) said they might be interested, and 43 (20.5%) said they were not. Altruistic reasons were most commonly given for wanting to take part, and concern about randomisation for not wanting to. Ultimately 57 people enrolled in the trial (27.1% of the original sample). Eighty-five people who initially expressed an interest did not enrol due to declining or not being eligible (for clinical reasons). Women and people from a white ethnic background were more likely to enrol in the trial, but no illness or treatment-related characteristics were associated with enrolment. CONCLUSION An acceptability study can be a useful tool for recruitment to challenging trials, but it may over-estimate recruitment.
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Affiliation(s)
- Georgina Ramsay
- Research and Development, North East London NHS Foundation Trust, Ilford, Essex, UK
| | - Zoë Haime
- University College London, Bloomsbury , UK
| | | | - Jacki L Stansfeld
- Research and Development, North East London NHS Foundation Trust, Ilford, Essex, UK
- University College London, Bloomsbury , UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Mile End, East London, UK
| | - Maria Long
- Research and Development, North East London NHS Foundation Trust, Ilford, Essex, UK
- University College London, Bloomsbury , UK
| | - Joanna Moncrieff
- Research and Development, North East London NHS Foundation Trust, Ilford, Essex, UK.
- University College London, Bloomsbury , UK.
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11
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Perra A, Galetti A, Zaccheddu R, Locci A, Piludu F, Preti A, Primavera D, Di Natale L, Nardi AE, Kurotshka PK, Cossu G, Sancassiani F, Stella G, De Lorenzo V, Zreik T, Carta MG. A Recovery-Oriented Program for People with Bipolar Disorder through Virtual Reality-Based Cognitive Remediation: Results of a Feasibility Randomized Clinical Trial. J Clin Med 2023; 12:jcm12062142. [PMID: 36983145 PMCID: PMC10056011 DOI: 10.3390/jcm12062142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021
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Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, University of Cagliari, 09124 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Alessia Galetti
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Aurora Locci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Piludu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, 10125 Turin, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | | | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giusy Stella
- Department of Mental Health and Pathological Addiction, ASL 5, 00034 Rome, Italy
| | | | - Thurayya Zreik
- Mental Health Service User Association, 11072070 Beirut, Lebanon
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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O'Sullivan Greene E, Shiely F. Recording and reporting of recruitment strategies in trial protocols, registries, and publications was nonexistent. J Clin Epidemiol 2022; 152:248-256. [PMID: 36273772 DOI: 10.1016/j.jclinepi.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate how trialists record and report their recruitment strategies and the recruiter details in trial protocols, registries, and publications. STUDY DESIGN AND SETTING A retrospective study of ovarian cancer (OC) trials between 2010 and 2021. We reviewed 154 trial publications, 30 protocols, 105 registry entries, and 26 trial websites associated with 88 phase III OC trials. RESULTS None of the 88 trials reviewed published a recruitment strategy or made reference to an available recruitment strategy for the trial. Only 31% (n = 28) made reference to the recruiter but this was reported only in the protocol so we have no evidence these named recruiters performed the task. None of the trials reviewed which closed early or extended recruitment timelines due to slow accrual, reported measures taken to improve recruitment rates before stoppages or changes took place. There were disparities in the reported target recruitment numbers between the protocol, the publication, and the registry. CONCLUSION Recruitment strategies exist, and we are sure most trial centers use recruitment strategies, but they need to be recorded and reported, as part of the supplementary material if not the main publication, so we can evaluate their effectiveness.
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Affiliation(s)
| | - Frances Shiely
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
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13
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Terraneo M, Quaglia V, Nuvolati G, Bani M, Russo S, Strepparava MG, Capici S, Cavaliere R, Cazzaniga ME. Social capital and willingness to participate in COVID-19 vaccine trials: an Italian case-control study. BMC Public Health 2022; 22:2137. [PMID: 36411406 PMCID: PMC9677898 DOI: 10.1186/s12889-022-14562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND What leads healthy people to enter in a volunteer register for clinical trials? This study aimed to investigate the relationship between the decision to volunteer in clinical trials for a COVID-19 vaccine and social capital, in a sample of healthy volunteers in Italy. Since social capital is characterized by trust, reciprocity, and social and political participation, we claim that it is key in leading individuals to actively take action to protect public health, and to take a risk for the (potential) benefit not only of themselves but for the entire community. METHODS This study was conducted through the administration of a questionnaire to healthy volunteers registered for a phase 1 clinical trial for a COVID-19 vaccine in the Unit Research Centre of ASST-Monza, in September 2020. The primary purpose of a phase 1 study is to evaluate the safety of a new drug candidate before it proceeds to further clinical studies. To approximate a case-control study, we randomly matched the 318 respondents to healthy volunteers (cases) with 318 people randomly selected by Round 9 of the European Social Survey (controls), using three variables, which we considered to be associated with the decision to volunteer: gender, age, and education level. To execute this matching procedure, we used the "ccmatch" module in STATA. RESULTS The findings highlight the positive impact of social capital in the choice of healthy individuals to volunteer in COVID-19 vaccine clinical trials. Controlling for possible confounding factors, some exemplary results show that people with a high level of general trust have a greater likelihood of volunteering compared to people with low trust (OR = 2.75, CI = 1.58-4.77); we also found that it is more probable that volunteers are people who have actively taken action to improve things compared with people who have not (for individuals who did three or more actions: OR = 7.54, CI = 4.10-13.86). People who reported voting (OR = 3.91, CI = 1.70-8.99) and participating in social activities more than other people of their age (OR = 2.89, CI = 1.82-4.60) showed a higher probability to volunteer. CONCLUSIONS Together with the adoption of urgent health measures in response to COVID-19, government policymakers should also promote social capital initiatives to encourage individuals to actively engage in actions aimed at protecting collective health. Our findings make an empirical contribution to the research on vaccines and its intersection with social behaviour, and they provide useful insights for policymakers to manage current and future disease outbreaks and to enhance the enrolment in vaccine trials.
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Affiliation(s)
- Marco Terraneo
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, University of Milano-Bicocca, Milan, Italy
| | - Valeria Quaglia
- grid.8042.e0000 0001 2188 0260Department of Political Science, Communication and International Relations, University of Macerata, Macerata, Italy
| | - Giampaolo Nuvolati
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, University of Milano-Bicocca, Milan, Italy
| | - Marco Bani
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Selena Russo
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Grazia Strepparava
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Clinical Psychology Unit, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Serena Capici
- Phase 1 Research Centre, ASST Monza, via Cadore 48, 20900 Monza, Italy
| | - Rebecca Cavaliere
- grid.4912.e0000 0004 0488 7120Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Marina Elena Cazzaniga
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy ,Phase 1 Research Centre, ASST Monza, via Cadore 48, 20900 Monza, Italy
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14
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Napier MP, Selvan K, Hayeems RZ, Shuman C, Chitayat D, Sutherland JE, Day MA, Héon E. Gene therapy: perspectives from young adults with Leber's congenital amaurosis. Eye (Lond) 2022; 36:2088-2093. [PMID: 34531550 PMCID: PMC9581997 DOI: 10.1038/s41433-021-01763-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
AIMS/PURPOSE To investigate Leber congenital amaurosis (LCA) patients' expectations, decision-making processes and gene therapy-related concerns. METHODS Using a qualitative approach, we explored perceptions of gene therapy and clinical trials among individuals with LCA. Young adults with a clinical diagnosis of LCA were recruited through the Ocular Genetics Programme at the Hospital for Sick Children. Semi-structured interviews were conducted with ten patients and analysed following the principles of qualitative description. RESULTS Study participants were aware of ongoing gene therapy research trials and actively sought information regarding advances in ophthalmology and vision restoration. The majority of participants would enrol or were enrolled in a gene-replacement therapy trial, while a minority was ambivalent or would not enrol if provided an opportunity. Participants attributed different values to clinical trials, which influenced their willingness to participate. Intrinsic factors related to coping, adaptation to vision loss and resilience also influenced decision-making. DISCUSSION This study highlights the complex factors involved in gene-therapy-related decision-making and acts as a proponent for adopting patient-centred care strategies when counselling individuals considering gene therapy or clinical trial participation.
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Affiliation(s)
- Melanie P Napier
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, ON, Canada
| | - Kavin Selvan
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robin Z Hayeems
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Child Health Evaluative Sciences (CHES) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cheryl Shuman
- Department of Pediatrics, Division of Clinical Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - David Chitayat
- Department of Pediatrics, Division of Clinical Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne E Sutherland
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Megan A Day
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elise Héon
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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15
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Pinho-Gomes AC, Gong J, Harris K, Woodward M, Carcel C. Dementia clinical trials over the past decade: are women fairly represented? BMJ Neurol Open 2022; 4:e000261. [PMID: 36110923 PMCID: PMC9445798 DOI: 10.1136/bmjno-2021-000261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background Lack of progress in finding disease-modifying treatments for dementia may be due to heterogeneity in treatment effects among subgroups, such as by sex. Therefore, we investigated the characteristics of dementia trials completed in the last decade, with a focus on women's representation and sex-disaggregated outcomes. Methods Clinical trials on dementia completed since 2010 were identified from ClinicalTrials.gov. Randomised, phase III/IV trials with ≥100 participants were selected to quantify women's representation among participants, by computing the participation to prevalence ratio (PPR) and investigate whether sex-disaggregated analyses had been performed. Results A total of 1351 trials were identified between January 2010 and August 2021 (429 520 participants), of which 118 were eligible for analysis of women's representation and sex-stratified analysis. Only 113 reported the sex of participants and were included in the analysis of women's representation. Of the 110 469 participants in these 113 trials, 58% were women, lower than their estimated representation in the global dementia population of 64%. The mean PPR was 0.90 (95% CI 0.86 to 0.94). Women's participation tended to be higher when the first or last authors of the trial report were women. Eight out of the 118 trials reported sex-disaggregated outcomes, and three of those found significant sex differences in efficacy outcomes. None of the trials reported screening failures or adverse events stratified by sex. Conclusions Overall, women and men were equally represented in dementia trials carried out over the past decade, but women's representation was lower than in the underlying dementia population. Sex-disaggregated efficacy and safety outcomes were rarely reported.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, Imperial College London, London, UK,Institute for Health Informatics, University College London, London, UK
| | - Jessica Gong
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK,The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
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Perception of clinical research among patients and healthy volunteers of clinical trials. Eur J Clin Pharmacol 2022; 78:1647-1655. [PMID: 35896802 PMCID: PMC9482583 DOI: 10.1007/s00228-022-03366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
Purpose Clinical research relies on data from patients and volunteers, yet the target sample size is often not achieved. Here, we assessed the perception of clinical research among clinical trial participants to improve the recruitment process for future studies. Methods We conducted a single-center descriptive and exploratory study of 300 current or former participants in various phase I–III clinical trials. Questionnaires were either distributed to current clinical trial participants or emailed to former subjects. Results Subjects strongly agreed or agreed that contributing to improving medical care (> 81%), contributing to scientific research (> 79%), and trusting their treating physicians (> 77%) were motives for study participation. Among healthy volunteers, financial motives positively correlated with the number of clinical trials they had participated in (p < 0.05). Higher age positively correlated with expectation of best available treatment during study participation among patients (p < 0.05). Less than 8% of all subjects expressed “great concern” about the potential risks of sharing their personal information as part of the study. Subjects displayed “great trust” or “trust” in medical staff (86.6%) and in government research institutions (76.4%), and “very little trust” or “little trust” in pharmaceutical companies (35.4%) and health insurance companies (16.9%). Conclusion Altruistic motives and trust in treating physicians were predominant motives for clinical trial participation. Older patients expected to receive the best available treatment during participation. Healthy volunteers who reported financial motives had participated in more clinical trials. Consistent with great trust in medical staff and government research institutions, little concern was expressed about the misuse of personal data during the trial. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03366-3.
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Moving the Dial Toward Equity in Parkinson's Disease Clinical Research: a Review of Current Literature and Future Directions in Diversifying PD Clinical Trial Participation. Curr Neurol Neurosci Rep 2022; 22:475-483. [PMID: 35713775 DOI: 10.1007/s11910-022-01212-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Parkinson's disease (PD), the second most common neurodegenerative disease, has a worldwide prevalence projected at 12 million by 2040. While PD has been extensively researched, our understanding of the disease is based on research studies that include mostly participants of European descent. The lack of diversity in clinical trial enrollment has limited the generalizability of scientific discoveries in the field. Here, we discuss contributors to racial and ethnic disparities in PD clinical research enrollment, summarize recently proposed and tested interventions, and propose next steps to increase equity and representation in PD research. RECENT FINDINGS Enrollment in PD clinical research is vulnerable to upstream disparities and inequities from PD awareness to access to specialized PD centers. While additional research is still needed, recent studies have identified some potential strategies for increasing underrepresented minority (URM) recruitment including increasing the availability of linguistically and culturally diverse research materials and team members, partnering with community organizations, and forming relationships with URM-serving community physicians. To move the dial toward equity in PD research, it will be necessary to implement known successful strategies and further investigate additional contributors to the underrepresentation of URMs in PD clinical research while developing and testing interventions to address these factors.
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Verweij ME, Gal R, Burbach JPM, Young-Afat DA, van der Velden JM, van der Graaf R, May AM, Relton C, Intven MP, Verkooijen HM. Most patients reported positively or neutrally of having served as controls in the Trials within Cohorts (TwiCs) design. J Clin Epidemiol 2022; 148:39-47. [DOI: 10.1016/j.jclinepi.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
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Morgan SE, Peng W, Occa A, Mao B, McFarlane S, Grinfeder G, Millet B, Byrne MM. Tailored Messages About Research Participation: Using an Interactive Information Aid to Improve Study Recruitment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:16-22. [PMID: 32533538 DOI: 10.1007/s13187-020-01775-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
After a diagnosis of cancer (or other serious disease), patients may be asked to consider joining a clinical trial. Because most people are unfamiliar with the scientific concepts that are necessary to the provision of meaningful informed consent, patient education is necessary. Increasing knowledge alone is not sufficient; understanding how clinical trial participation aligns with personal circumstances and knowledge is central to the decision-making process. In this study, 302 cancer patients and survivors evaluated an interactive information aid (IA) designed to inform their decision to join a research study or clinical trial by providing tailored information to patients' responses to questions pertaining to seven key barriers or facilitators of clinical trial participation. The development of the IA was done with input from the authors' Clinical Translational Science Institute; linked components of the IA were vetted by members and leaders of the institution's NCI-designated comprehensive cancer center. Results of the study indicated that the information aid was successful in significantly reducing fears and increasing knowledge, attitudes, perceived behavioral control, and behavioral intentions about research participation relative to a control condition. Thus, an interactive information aid that provides information that is responsive to patients' values, knowledge, and personal circumstances can help patients to be better prepared to consider a decision about research participation.
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Affiliation(s)
- Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, USA.
| | - Wei Peng
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, USA
| | - Aurora Occa
- Department of Communication Studies, University of Kentucky, Lexington, KY, USA
| | - Bingjing Mao
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, USA
| | - Soroya McFarlane
- Department of Communication Studies, University of Georgia, Athens, GA, USA
| | - Gilles Grinfeder
- Department of Interactive Media, University of Miami, Coral Gables, FL, USA
| | - Barbara Millet
- Department of Interactive Media, University of Miami, Coral Gables, FL, USA
| | - Margaret M Byrne
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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20
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Ginossar T, Diaz Fuentes C, Oetzel J. Understanding Willingness to Participate in Cancer Clinical Trials Among Patients and Caregivers Attending a Minority-Serving Academic Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:179-187. [PMID: 32666504 PMCID: PMC10685662 DOI: 10.1007/s13187-020-01802-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advances in cancer treatment are impeded by low accrual rates of patients to cancer clinical trials (CCTs). The national rates of recruitment of underserved groups, including racial/ethnic minorities, are limiting the generalizability of research findings and are likely to enhance inequities in cancer outcomes. The goal of this study was to examine willingness to participate (WTP) in CCTs and factors associated with this willingness among patients and caregivers attending a minority-serving university cancer center in the Southwest. A cross-sectional survey design was utilized (n = 236, 135 patients and 101 caregivers). Fear was the strongest predictor of WTP in CCTs. The only ethnic differences observed related to Spanish-speaking patients exhibiting increased WTP in CCTs, and Spanish-speaking caregivers' decreased WTP, compared to others. These results underscore the importance of future interventions to reduce CCT-related fear among patients and caregivers, with particular need for family-focused tailored interventions designed to meet the needs of Spanish-speaking patients and caregivers.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, 87103, USA.
| | | | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, 3240, New Zealand
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21
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Hu K, Tardif JC, Huber M, Daly M, Langford AT, Kirby R, Rosenberg Y, Hochman J, Joshi A, Bassevitch Z, Pillinger MH, Shah B. Chasing the storm: Recruiting non-hospitalized patients for a multi-site randomized controlled trial in the United States during the COVID-19 pandemic. Clin Transl Sci 2021; 15:831-837. [PMID: 34953032 PMCID: PMC9010275 DOI: 10.1111/cts.13211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Randomized controlled trials (RCTs) remain the gold standard to evaluate clinical interventions, producing the highest level of evidence while minimizing potential bias. Inadequate recruitment is a commonly encountered problem that undermines the completion and generalizability of RCTs—and is even more challenging when enrolling amidst a pandemic. Here, we reflect on our experiences with virtual recruitment of non‐hospitalized patients in the United States for ColCorona, an international, multicenter, randomized, placebo‐controlled coronavirus disease 2019 (COVID‐19) drug trial. Recruitment challenges during a pandemic include constraints created by shelter‐in‐place policies and targeting enrollment according to national and local fluctuations in infection rate. Presenting a study to potential participants who are sick with COVID‐19 and may be frightened, overwhelmed, or mistrusting of clinical research remains a challenge. Strategies previously reported to improve recruitment include transparency, patient and site education, financial incentives, and person‐to‐person outreach. Active measures taken during ColCorona to optimize United States recruitment involved rapid expansion of sites, adjustment of recruitment scripts, assessing telephone calls versus text messages for initial contact with participants, institutional review board‐approved financial compensation, creating an infrastructure to systematically identify potentially eligible patients, partnering with testing sites, appealing to both self‐interest and altruism, and large‐scale media efforts with varying degrees of success.
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Affiliation(s)
- Kelly Hu
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Melanie Huber
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Maria Daly
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Ruth Kirby
- National Heart Lung Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yves Rosenberg
- National Heart Lung Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Judith Hochman
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Avni Joshi
- Division of Allergy/Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael H Pillinger
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Section of Rheumatology, Department of Medicine, United States Department of Veterans Affairs, New York, New York, USA
| | - Binita Shah
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Section of Cardiology, Department of Medicine, United States Department of Veterans Affairs, New York, New York, USA
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22
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Michos ED, Reddy TK, Gulati M, Brewer LC, Bond RM, Velarde GP, Bailey AL, Echols MR, Nasser SA, Bays HE, Navar AM, Ferdinand KC. Improving the enrollment of women and racially/ethnically diverse populations in cardiovascular clinical trials: An ASPC practice statement. Am J Prev Cardiol 2021; 8:100250. [PMID: 34485967 PMCID: PMC8408620 DOI: 10.1016/j.ajpc.2021.100250] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death for both women and men worldwide. In the United States (U.S.), there are significant disparities in cardiovascular risk factors and CVD outcomes among racial and ethnic minority populations, some of whom have the highest U.S. CVD incidence and mortality. Despite this, women and racial/ethnic minority populations remain underrepresented in cardiovascular clinical trials, relative to their disease burden and population percentage. The lack of diverse participants in trials is not only a moral and ethical issue, but a scientific concern, as it can limit application of future therapies. Providing comprehensive demographic data by sex and race/ethnicity and increasing representation of diverse participants into clinical trials are essential in assessing accurate drug response, safety and efficacy information. Additionally, diversifying investigators and clinical trial staff may assist with connecting to the language, customs, and beliefs of study populations and increase recruitment of participants from diverse backgrounds. In this review, a working group for the American Society for Preventive Cardiology (ASPC) reviewed the literature regarding the inclusion of women and individuals of diverse backgrounds into cardiovascular clinical trials, focusing on prevention, and provided recommendations of best practices for improving enrollment to be more representative of the U.S. society into trials.
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Affiliation(s)
- Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Tina K. Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA
| | - LaPrincess C. Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Rachel M. Bond
- Internal Medicine, Creighton University School of Medicine, Chandler, AZ USA
- Women's Heart Health, Dignity Health, AZ USA
| | - Gladys P. Velarde
- Division of Cardiology, University of Florida Health, Jacksonville, FL USA
| | | | - Melvin R. Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA USA
| | - Samar A. Nasser
- Division of Clinical Research and Leadership, George Washington University School of Medicine, Washington, DC USA
| | - Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
| | - Ann Marie Navar
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX USA
| | - Keith C. Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA USA
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23
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Karampatakis D, Kakavouti-Doudos A, Oikonomidis P, Voultsos P. Translation and validation of the greek version of a questionnaire measuring patient views on participation in clinical trials. BMC Health Serv Res 2021; 21:1135. [PMID: 34674689 PMCID: PMC8530543 DOI: 10.1186/s12913-021-07111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background The increasing number of clinical research opportunities requires increasing numbers of participants in clinical trials. However, it may become increasingly problematic, as protocols have become increasingly complex. Better understanding of patients’ attitudes towards their potential participation in clinical trials is essential for developing effective clinical trial recruitment strategies. In Greece, limited research has been conducted on this topic so far. This study aims to contribute to filling this gap. Methods A cross-sectional study was conducted. Purposive sampling was used to select participants. The Greek version of a recently developed questionnaire measuring patient views on participation in clinical trials, a 27-item scale distributed into four factors, was tested. In addition, participants were asked to provide information regarding their socio-demographics. A demographic comparison was conducted. Results The four-factor solution derived in our study consisted of the same 27 items and it was different from the six-factor solution that Arnetz et al. proposed. The factors risks and benefits, that consisted of 5 and 3 items respectively in the six-factor solution, were merged into one factor that consisted of 10 items in the four-factor solution. The four factors produced were Risks and benefits (ten items, α = 0,867), Patient’s expectations (six items, α = 0.864), Patient’s participation (five items, α = 0.827), and Cost and convenience (five items, α = 0,770). We found that demographic factors did not impact patients’ opinions about clinical trials participation, except for gender. The participants reported as important for participating in clinical trial: receiving clear and adequate information (95,5 %) and being given the opportunity to ask questions (97,8 %), take part in discussions regarding their own treatment (94,6 %), and voice their concerns and opinions (91,1 %). As factors strongly associated with participants’ willingness to participate in a clinical trial were reported: concerns about the risks of being in a clinical trial (87,5 %), the possible side effects of clinical trials (86,3 %), the type of treatment given in a clinical trial (83,7 %), and whether participation would improve their quality of life (QoL) (81,5 %). Conclusions The preliminary validation of the Greek version of the questionnaire measuring patient perceptions and expectations of participating in clinical trials demonstrated acceptable validity and reliability and could be further tested in larger samples. The findings that emerged from this study are in line with previous literature. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07111-x.
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Affiliation(s)
- Dimitrios Karampatakis
- 1st University Eye Clinic, School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Angeliki Kakavouti-Doudos
- 1st University Eye Clinic, School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Panagiotis Oikonomidis
- 1st University Eye Clinic, School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece.
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24
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Cardenas V, Rahman A, Giulioni J, Coulourides Kogan A, Enguidanos S. Patient and physician perspectives on engaging in palliative and healthcare trials: a qualitative descriptive study. BMC Palliat Care 2021; 20:158. [PMID: 34645442 PMCID: PMC8515687 DOI: 10.1186/s12904-021-00856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background Researchers are encountering increasing challenges in recruiting participants for palliative and healthcare research. This paper aims to understand challenges to and methods for engaging physicians and seriously ill patients and their caregivers in research studies. Methods Between October 2019 to July 2020, we conducted qualitative interviews with 25 patients, proxies, and caregivers participants who were eligible for a randomized controlled trial of home-based palliative care and 31 physicians from participating accountable care organizations. Using thematic analysis, we analyzed participants’ responses to identify concepts and key ideas within the text. From these initial concepts, core themes around barriers to research and preferred research recruitment approaches were generated. Results Themes from patient and caregiver interviews included time constraints, privacy concerns, lack of research familiarity, disconnect with research institution, self-perceived health status, and concerns with study randomization. Physician-identified barriers focused on time constraints and study randomization. Patient and caregiver recommendations for study recruitment included in-person recruitment, recruitment at healthcare providers’ offices, recruitment via mail, additional study information, and frequent calls. Physician recommendations were related to placement of flyers at clinics, financial incentives, and formal events. Conclusions Findings demonstrated that although patients and caregivers prefer that their physicians recruit them for health-related research studies, physicians identified time constraints as a consistent barrier to research involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00856-6.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
| | - Jenna Giulioni
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, USA
| | - Alexis Coulourides Kogan
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Keck School of Medicine, Department of Family Medicine and Geriatrics, University of Southern California , Alhambra, CA, 91803, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
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25
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Ericson J, Anagrius C, Rygaard A, Guntram L, Wendel SB, Hesselman S. Women's experiences of receiving information about and consenting or declining to participate in a randomized controlled trial involving episiotomy in vacuum-assisted delivery: a qualitative study. Trials 2021; 22:658. [PMID: 34565424 PMCID: PMC8474868 DOI: 10.1186/s13063-021-05624-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Information about and invitation to participate in a clinical trial involving an intervention during childbirth may cause fear or worry in pregnant women. The aim of this study was to describe nulliparous women’s experiences of receiving an invitation to participate in a randomized controlled trial (RCT) of lateral episiotomy versus no episiotomy in vacuum-assisted delivery (EVA trial). Methods This qualitative study was nested in the ongoing EVA trial. Data were collected through semistructured telephone interviews with 23 women regarding their experiences of the information and invitation to participate in the EVA trial. Interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was used to analyse the interview contents. Results Three main experience categories were identified among the participants. “Timing of trial information and understanding” revealed that women preferred to obtain information about the trial early on during pregnancy. “Reasons to consent to or decline participation in the trial” encompassed a variety of reasons for women to consent, such as goodwill for science or personal benefits, or to decline, such as not wanting to be randomized or fear of increased risk of having a vacuum-assisted delivery. “Thoughts evoked regarding childbirth” were diverse, ranging from not being affected at all to having increased anxiety. Conclusions The women’s experience of receiving an invitation to participate in an RCT of episiotomy in vacuum-assisted delivery varied widely, from immediately giving consent without further worries to increased anxiety or declining participation. Early and personal information with time for reflection was considered most satisfactory. Trial registration ClinicalTrials.govNCT02643108. Registered on December 28, 2015. The Lateral Episiotomy or Not in Vacuum Assisted Delivery in Non-parous Women (EVA) trial was registered at www.clinicaltrials.gov.
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Affiliation(s)
- Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. .,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden. .,Department of Pediatrics, Falu Hospital, Falun, Sweden.
| | - Cecilia Anagrius
- Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden
| | - Agnes Rygaard
- Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden
| | - Lisa Guntram
- Department of Thematic Studies - Technology and Social Change, Linköping University, Linköping, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Susanne Hesselman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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26
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Murphy E, O'Keeffe A, O Shea N, Long E, Eustace JA, Shiely F. Patient perceptions of the challenges of recruitment to a renal randomised trial registry: a pilot questionnaire-based study. Trials 2021; 22:597. [PMID: 34488851 PMCID: PMC8420031 DOI: 10.1186/s13063-021-05526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Randomised controlled trials (RCTs) are the gold standard for demonstrating the efficacy of new therapies. However, issues of external validity often affect result application to real-world settings. Using registries to conduct RCTs is a reasonably new practice, but is appealing because it combines the benefits of both observational studies and RCTs. There is limited literature on patient motivators, barriers, and consent to registries for conducting RCTs. The purpose of our study was to establish the factors that motivate and/or inhibit patients from joining a registry for RCTs and to determine what information matters to patients when making an enrolment decision to participate in such a registry. Methods We conducted a cross-sectional questionnaire-based study at a dialysis centre in Southwest Ireland representing a catchment patient population of approximately 430,000. Quantitative data were coded and analysed in SPSS (v16). Descriptive statistics were produced, and open-ended questions were analysed by thematic analysis. Results Eighty-seven patients completed the questionnaire. Reasons for participation in a registry included personal and altruistic benefits. Barriers to participation were time and travel requirements associated with registry participation, data safety concerns, risks, side effects, and concerns that registry participation would impact current treatment. Although 29.8% of patients expressed concern regarding their data being stored in a registry, 79.3% were still willing to consent to have their data uploaded and stored in a registry for conducting RCTs. It was important to patients to have their GP (general practitioner) involved in the decision to participate, despite little day-to-day contact with their GP for renal dialysis management. Conclusion Challenges to recruitment to registries for RCTs exist, but addressing the identified concerns of potential participants may aid patients in making a more informed enrolment decision and may improve recruitment to registries, and by extension, to RCTs conducted using the registry. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05526-9.
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Affiliation(s)
- Ellen Murphy
- TRAMS (Trials Research and Methodologies Unit), HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Aoife O'Keeffe
- TRAMS (Trials Research and Methodologies Unit), HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Niamh O Shea
- TRAMS (Trials Research and Methodologies Unit), HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Eva Long
- Department of Nephrology, Cork University Hospital, Cork, Ireland
| | - Joseph A Eustace
- TRAMS (Trials Research and Methodologies Unit), HRB Clinical Research Facility, University College Cork, Cork, Ireland.,Department of Nephrology, Cork University Hospital, Cork, Ireland
| | - Frances Shiely
- TRAMS (Trials Research and Methodologies Unit), HRB Clinical Research Facility, University College Cork, Cork, Ireland. .,HRB Clinical Research Facility and School of Public Health, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland.
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27
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De Sutter E, Borry P, Geerts D, Huys I. Personalized and long-term electronic informed consent in clinical research: stakeholder views. BMC Med Ethics 2021; 22:108. [PMID: 34332572 PMCID: PMC8325412 DOI: 10.1186/s12910-021-00675-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The landscape of clinical research has evolved over the past decade. With technological advances, the practice of using electronic informed consent (eIC) has emerged. However, a number of challenges hinder the successful and widespread deployment of eIC in clinical research. Therefore, we aimed to investigate the views of various stakeholders on the potential advantages and challenges of eIC. Methods Semi-structured interviews were conducted with 39 participants from 5 stakeholder groups from across 11 European countries. The stakeholder groups included physicians, patient organization representatives, regulator representatives, ethics committee members, and pharmaceutical industry representatives, and all were involved in clinical research. Interviews were analyzed using the framework method. Results Interviewees identified that a powerful feature of eIC is its personalized approach as it may increase participant empowerment. However, they identified several ethical and practical challenges, such as ensuring research participants are not overloaded with information and offering the same options to research participants who would prefer a paper-based informed consent rather than eIC. According to the interviewees, eIC has the potential to establish efficient long-term interactions between the research participants and the research team in order to keep the participants informed during and after the study. Interviewees emphasized that a personal interaction with the research team is of utmost importance and this cannot be replaced by an electronic platform. In addition, interviewees across the stakeholder groups supported the idea of having a harmonized eIC approach across the European Member States. Conclusions Interviewees reported a range of design and implementation challenges which needs to be overcome to foster innovation in informing research participants and obtaining their consent electronically. It was considered important that the implementation of eIC runs alongside the face-to-face contact between research participants and the research team. Moreover, interviewees expect that eIC could offer the opportunity to enable a personalized approach and to strengthen continuous communication over time. If successfully implemented, eIC may facilitate the engagement of research participants in clinical research. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00675-7.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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28
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van der Hout A, van Uden-Kraan C, Holtmaat K, Jansen F, Lissenberg-Witte B, Nieuwenhuijzen G, Hardillo J, Baatenburg de Jong R, Tiren-Verbeet N, Sommeijer D, de Heer K, Schaar C, Sedee R, Bosscha K, van den Brekel M, Petersen J, Westerman M, Honings J, Takes R, Houtenbos I, van den Broek W, de Bree R, Jansen P, Eerenstein S, Leemans C, Zijlstra J, Cuijpers P, van de Poll-Franse L, Verdonck-de Leeuw I. Reasons for not reaching or using web-based self-management applications, and the use and evaluation of Oncokompas among cancer survivors, in the context of a randomised controlled trial. Internet Interv 2021; 25:100429. [PMID: 34401388 PMCID: PMC8350584 DOI: 10.1016/j.invent.2021.100429] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The web-based self-management application Oncokompas was developed to support cancer survivors to monitor health-related quality of life and symptoms (Measure) and to provide tailored information (Learn) and supportive care options (Act). In a previously reported randomised controlled trial (RCT), 68% of 655 recruited survivors were eligible, and of those 45% participated in the RCT. Among participants of the RCT that were randomised to the intervention group, 52% used Oncokompas as intended. The aim of this study was to explore reasons for not participating in the RCT, and reasons for not using Oncokompas among non-users, and the use and evaluation of Oncokompas among users. METHODS Reasons for not participating were assessed with a study-specific questionnaire among 243 survivors who declined participation. Usage was investigated among 320 participants randomised to the intervention group of the RCT via system data and a study-specific questionnaire that was assessed during the 1 week follow-up (T1) assessment. RESULTS Main reasons for not participating were not interested in participation in scientific research (40%) and not interested in scientific research and Oncokompas (28%). Main reasons for not being interested in Oncokompas were wanting to leave the period of being ill behind (29%), no symptom burden (23%), or lacking internet skills (18%). Out of the 320 participants in the intervention group 167 (52%) used Oncokompas as intended. Among 72 non-users, main reasons for not using Oncokompas were no symptom burden (32%) or lack of time (26%). Among 248 survivors that activated their account, satisfaction and user-friendliness were rated with a 7 (scale 0-10). Within 3 (IQR 1-4) sessions, users selected 32 (IQR 6-37) topics. Main reasons for not using healthcare options in Act were that the information in Learn was already sufficient (44%) or no supportive care needs (32%). DISCUSSION Main reasons for not reaching or using Oncokompas were no symptom burden, no supportive care needs, or lack of time. Users selected many cancer-generic and tumour-specific topics to address, indicating added value of the wide range of available topics.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - C.F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - B.I. Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | | | - J.A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R.J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N.L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - D.W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - C.G. Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, the Netherlands
| | - R.J.E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - M.W.M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J.F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, the Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R.P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - S.E.J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - C.R. Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - J.M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - L.V. van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, the Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - I.M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
- Corresponding author at: Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Fallowfield L, Boyle FM, Travado L, Kiely BE, Jewell P, Aubel D, Cardoso F. Gaps in Care and Support for Patients With Advanced Breast Cancer: A Report From the Advanced Breast Cancer Global Alliance. JCO Glob Oncol 2021; 7:976-984. [PMID: 34156869 PMCID: PMC8457864 DOI: 10.1200/go.21.00045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although new therapeutic options continue to improve disease-related outcomes in advanced breast cancer (ABC), enhanced focus is needed to improve quality of life for patients currently living with ABC. METHODS In November 2019, a multidisciplinary workshop to explore patient perceptions of their information and support needs was held at the ABC Global Alliance Annual Meeting in Lisbon, Portugal. Ninety-two attendees from 27 countries participated in the workshop. RESULTS Several key unmet needs were identified and discussed in the workshop, including the following: (1) Significant patient knowledge gaps exist related to the diagnosis and management of ABC, and the availability of patient-focused information to support these gaps in knowledge remains limited. (2) The development of meaningful relationships between patients and health care professionals, and the role of patients in decision making, is often overlooked for patients with ABC. (3) Multidisciplinary care approaches are crucial for patients with ABC; however, these often lack effective coordination. (4) Access to clinical trials for ABC also remains limited. (5) Caregivers, friends, and family members do not receive sufficient guidance to support patients with ABC and manage their own well-being. CONCLUSION The variety of unmet needs explored in the workshop demonstrates that patients with ABC still face considerable challenges related to quality of care and support, which will not be resolved until tangible action is taken. Issues highlighted in the workshop should be prioritized by working groups to shape the development of community-based solutions. There is a need for the global community to act proactively to maximize awareness of these ongoing unmet needs and existing resources, while socializing and building new initiatives and resources that will help to close these gaps for patients.
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Affiliation(s)
- Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Frances M. Boyle
- Mater Hospital North Sydney, University of Sydney, Sydney, Australia
| | - Luzia Travado
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Belinda E. Kiely
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Dawn Aubel
- Novartis AG, East Hanover, NJ
- Columbia University, New York, NY
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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Occa A, Morgan SE, Peng W, Mao B, McFarlane SJ, Grinfeder K, Byrne M. Untangling interactivity's effects: The role of cognitive absorption, perceived visual informativeness, and cancer information overload. PATIENT EDUCATION AND COUNSELING 2021; 104:1059-1065. [PMID: 33969824 PMCID: PMC8110950 DOI: 10.1016/j.pec.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Learning about clinical trials is as stressful and challenging for cancer patients as it is for the clinical staff who provide education to patients. Information aids (IAs) can support both discussions and patients' decision-making, especially when IAs offer interactive features that provide information based on individuals' needs and experiences. However, it is not clear which factors contribute to interactive IAs' effectiveness. METHODS An experiment with cancer patients and survivors (n = 313) compared the effects of two IAs about clinical trial participation: one with modality (i.e. website/technological) interactivity only and one with both modality and message interactivity (i.e. provides information contingent on individual users' information needs). RESULTS The IA with both modality and message interactivity features elicited the higher perceived visual informativeness (PVI) and cognitive absorption (CA) scores. The model supports the moderating role of PVI and cancer information overload (CIO), and the mediating role of CA. CONCLUSION The IA with both modality and message interactivity better supported individuals' decision-making and improved attitudes and knowledge scores. CIO was experienced more by participants using the modality interactivity-only IA. PRACTICE IMPLICATIONS Message interactivity may simplify individuals' cognitive processes. IAs about clinical trial participation should include both message and modality interactivity.
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Affiliation(s)
- Aurora Occa
- Department of Communication, University of Kentucky, United States.
| | - Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, United States
| | - Wei Peng
- The Edward R. Murrow College of Communication, Washington State University, United States
| | - Bingjing Mao
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, United States
| | - Soroya Julian McFarlane
- Department of Communication Studies, University of Georgia, Athens, GA, 30602, United States
| | - Kim Grinfeder
- Department of Interactive Media, University of Miami, Coral Gables, FL, 33146, United States
| | - Margaret Byrne
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, 33612, United States
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Schultz É, Ward JK, Atlani-Duault L, Holmes SM, Mancini J. French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052611. [PMID: 33807787 PMCID: PMC7967331 DOI: 10.3390/ijerph18052611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic put clinical research in the media spotlight globally. This article proposes a first measure of familiarity with and attitude toward clinical research in France. Drawing from the “Health Literacy Survey 2019” (HLS19) conducted online between 27 May and 5 June 2020 on a sample of the French adult population (N = 1003), we show that a significant proportion of the French population claimed some familiarity with clinical trials (64.8%) and had positive attitudes (72%) toward them. One of the important findings of this study is that positive attitudes toward clinical research exist side by side with a strong distancing from the pharmaceutical industry. While respondents acknowledged that the pharmaceutical industry plays an important role in clinical research (68.3%), only one-quarter indicated that they trust the industry (25.7%). Positive attitudes toward clinical trials were associated with familiarity with clinical trials (Odds Ratio, OR 2.97 [1.90–4.63]), financial difficulties (OR 0.63 [0.46–0.85]), as well as mistrust of doctors (0.48 [0.27–0.85]) and of scientists (OR 0.62 [0.38–0.99]). Although the French media provided a great deal of information on how clinical research works during the first months of the pandemic, there remains profound mistrust of the pharmaceutical industry in France. This suspicion can undermine crisis management, especially in the areas of vaccine development and preparation for future pandemics.
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Affiliation(s)
- Émilien Schultz
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Correspondence:
| | - Jeremy K. Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94801 Villejuif, France;
- VITROME, Aix-Marseille University, IRD, AP-HM, SSA, 13005 Marseille, France
| | - Laëtitia Atlani-Duault
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- Institut COVID-19 Add Memoriam, University of Paris, 75006 Paris, France
- WHO Collaborative Center for Research on Health and Humanitarian Policies and Practices, IRD, Université de Paris, 75006 Paris, France
| | - Seth M. Holmes
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Society and Environment, Medical Anthropology, and Public Health, University of Berkeley, Berkeley, CA 94720, USA
- Mediterranean Institute for Advanced Study IMéRA, Institut Paoli Calmettes, Aix-Marseille University, 13004 Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- BioSTIC, APHM, Timone, 13005 Marseille, France
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Ohsumi S, Mukai H, Takahashi M, Hozumi Y, Akabane H, Park Y, Tokunaga E, Takashima T, Watanabe T, Sagara Y, Kaneko T, Ohashi Y. Factors affecting enrollment in randomized controlled trials conducted for patients with metastatic breast cancer. Jpn J Clin Oncol 2020; 50:873-881. [PMID: 32463090 DOI: 10.1093/jjco/hyaa065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is critical to obtain informed consent from eligible patients to complete clinical trials. We investigated the factors that affect the participation rates of eligible patients. PATIENTS AND METHODS Patients with metastatic breast cancer who were eligible for SELECT BC or SELECT BC-CONFIRM trials, randomized controlled trials conducted for patients with chemotherapy-naive metastatic breast cancer were recruited to prospective studies, SELECT BC-FEEL and SELECT BC-FEEL II, respectively. SELECT BC FEEL and SELECT BC-FEEL II were conducted to identify the factors affecting the rates at which informed consent was obtained, using a self-administered questionnaire we developed. RESULTS In total, 232 patients participated in the studies. The patients who agreed to take part in the randomized trials were more likely than the refusers to answer that they decided to participate because: 'My doctor wanted me to participate in this trial' (P = 0.00000), ' My family or friends wanted me to participate in this trial' (P = 0.00000), 'Both treatment regimens used in the trial are suitable to me' (P = 0.00383), 'I know that the trial is conducted to determine which is a better treatment' (P = 0.01196), and ' I think that my participation in the trial will contribute to the benefit to future patients with the same disease' (P = 0.00756). CONCLUSIONS To enhance the consent rate in randomized trials of metastatic breast cancer patients, concepts of the trials must be considered important and acceptable not only by patients but also by doctors and their families.
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama 791-0280, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo
| | - Yasuo Hozumi
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Kasama
| | | | - Youngjin Park
- Department of Breast and Endocrine Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai
| | - Eriko Tokunaga
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai
| | - Yoshiaki Sagara
- Department of Breast Oncology, Hakuaikai Medical Corp Sagara Hospital, Kagoshima
| | - Tetsuji Kaneko
- Department of Clinical Research, Tokyo Metropolitan Children's Medical Center, Fuchu
| | - Yasuo Ohashi
- Faculty of Science and Engineering, Chuo University, Tokyo
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Li Q, Lin J, Chi A, Davies S. Practical considerations of utilizing propensity score methods in clinical development using real-world and historical data. Contemp Clin Trials 2020; 97:106123. [PMID: 32853779 DOI: 10.1016/j.cct.2020.106123] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022]
Abstract
In recent years, with the rapid increase in the volume and accessibility of Real-World-Data (RWD) and Real-World-Evidence (RWE), we have seen the unprecedented opportunities for their use in drug clinical development and life-cycle management. RWD and RWE have demonstrated the significant potential to improve the design, planning, and execution of clinical development. Furthermore, they can feature in the designs as either a substitute or compliment to traditional clinical trials. However, to utilize RWD and RWE appropriately and wisely, it is critical to apply rigorous statistical methodologies that enable the robustness of results to be characterized and ascertained. Several statistical methodologies including exact matching, propensity score methods, matching-adjusted indirect comparisons and meta-analysis have been proposed for analyzing RWD. Among them, propensity score method is one of the most commonly used methods for non-randomized trials with indirect comparison. Although massive methodologies and examples have been published and discussed since propensity score methods were introduced, systematic review and discussion of how to rigorously use propensity score methods in the practical clinical development is still deficient. This paper introduces commonly used and emerging propensity score methods with detailed discussions of their pros and cons. Three different case studies are presented to illustrate the practical considerations of utilizing propensity score methods in the study design and evaluation using real-world and historical data. Additional considerations including selection of patient populations, endpoints, baseline covariates, propensity score methods, sensitivity analysis and practical implementation flow in clinical development will be discussed.
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Affiliation(s)
- Qing Li
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States.
| | - Jianchang Lin
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States
| | - Andy Chi
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States
| | - Simon Davies
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States
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Important considerations prior to elimination of breast cancer surgery after neoadjuvant systemic therapy: Listening to what our patients want. Ann Oncol 2020; 31:1083-1084. [DOI: 10.1016/j.annonc.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
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Kearns C, Feighery R, Mc Caffrey J, Higgins M, Smith M, Murphy V, O’Reilly S, Horgan AM, Walshe J, McDermott R, Morris PG, Keane M, Martin M, Murphy C, Duffy K, Mihai A, Armstrong J, O’Donnell DM, Gallagher WM, Kelly CM, Kelly CM. Understanding and Attitudes toward Cancer Clinical Trials among Patients with a Cancer Diagnosis: National Study through Cancer Trials Ireland. Cancers (Basel) 2020; 12:cancers12071921. [PMID: 32708702 PMCID: PMC7409272 DOI: 10.3390/cancers12071921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Cancer clinical trials (CCTs) are critical to translation and development of better therapies to improve outcomes. CCTs require adequate patient involvement but accrual rates are low globally. Several known barriers impede participation and knowing how subpopulations differ in understanding of CCTs can foster targeted approaches to aid accrual and advance cancer treatments. We conducted the first nationwide survey of 1089 patients attending 14 Irish cancer centres, assessing understanding of fundamental concepts in CCT methodology and factors that influence participation, to help tailor patient support for accrual to CCTs. Two-thirds (66%) of patients reported never having been offered a CCT and only 5% of those not offered asked to participate. Misunderstanding of clinical equipoise was prevalent. There were differences in understanding of randomisation of treatment by age (p < 0.0001), ethnicity (p = 0.035) and marital status (p = 0.013), and 58% of patients and 61% previous CCT participants thought that their doctor would ensure better treatment in CCTs. Females were slightly more risk averse. Males indicated a greater willingness to participate in novel drug trials (p = 0.001, p = 0.003). The study identified disparities in several demographics; older, widowed, living in provincial small towns and fewer years-educated patients had generally poorer understanding of CCTs, highlighting requirements for targeted support in these groups.
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Affiliation(s)
- Cathriona Kearns
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Correspondence: (C.K.); (C.M.K.)
| | - Ronan Feighery
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - John Mc Caffrey
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Michaela Higgins
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Martina Smith
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Verena Murphy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Seamus O’Reilly
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Cork University Hospital, T12DFK4 Cork, Ireland
| | - Anne M. Horgan
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- University Hospital Waterford, X91ER8E Waterford, Ireland
| | - Janice Walshe
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. Vincent University Hospital, D04YN63 Dublin, Ireland
| | - Ray McDermott
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Adelaide & Meath Hospital Incorporating the National Children’s Hospital (AMNCH), D24KNE0 Dublin, Ireland
| | - Patrick G. Morris
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Beaumont Hospital, D09A0KH Dublin, Ireland
| | - Maccon Keane
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Galway University Hospital, SW4794 Galway, Ireland
| | - Michael Martin
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Sligo General Hospital, F91H684 Sligo, Ireland
| | - Conleth Murphy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Bon Secours Hospital, T12DV56 Cork, Ireland
| | - Karen Duffy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Letterkenny General Hospital, F92FC82 Donegal, Ireland
| | - Alina Mihai
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Beacon Hospital, D18AK68 Dublin, Ireland
| | - John Armstrong
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. Luke’s Radiation Oncology Network, St Luke’s Hospital, Rathgar, D06HH36 Dublin, Ireland
| | - Dearbhaile M. O’Donnell
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. James’s Hospital, D08W9RT Dublin, Ireland
| | - William M. Gallagher
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Ciara M. Kelly
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Catherine M. Kelly
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Correspondence: (C.K.); (C.M.K.)
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Knelson LP, Cukras AR, Savoie J, Agarwal A, Guo H, Hu J, Fell G, Lederman R, Hughes ME, Winer EP, Lin NU, Tolaney SM. Barriers to Clinical Trial Accrual: Perspectives of Community-Based Providers. Clin Breast Cancer 2020; 20:395-401.e3. [PMID: 32605813 DOI: 10.1016/j.clbc.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only a small proportion of patients with cancer enroll onto clinical trials. Previous studies have explored patient-related barriers to trial participation; however, few studies have focused on the provider perspective. We aimed to describe referral practices and barriers to referrals of patients with breast cancer for clinical trials, including the utilization of web-based trial-matching tools. MATERIALS AND METHODS In 2016, we distributed 120 surveys to attendees of a breast oncology continuing medical education course. The survey addressed referral patterns, trial knowledge, and perceptions of web-based trial-matching tools. After survey completion, participants were provided a link to the Dana-Farber Cancer Institute trial-matching tool. Three months later, a follow-up survey was sent to assess their use of this tool. Descriptive statistics were used to summarize survey data. RESULTS Ninety-six (80%) participants completed the first survey; 5 respondents did not actively treat patients with breast cancer and were excluded. Respondents included medical (30%) and surgical (22%) oncologists, nurse practitioners/physician assistants (26%), and other (22%). Neoadjuvant and metastatic trials were deemed the highest priority. The primary reported barriers included perceived lack of patient interest, lack of trial awareness, and logistical barriers. Emailing trial investigators directly was the preferred method of trial referral. Although 80% indicated that web-based tools would increase trial referrals, our follow-up survey revealed that only 18% of respondents used our web-based tool. CONCLUSION Our respondents valued trial participation for their patients but found it difficult to manage. Further research is needed regarding how to increase the likelihood that patients are presented with appropriate trial options.
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Affiliation(s)
- Lauren P Knelson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Anthony R Cukras
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jennifer Savoie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ankit Agarwal
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hao Guo
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Jiani Hu
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Geoffrey Fell
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Ruth Lederman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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Bentley C, Cooper L, Foster M, Fallowfield J. Reflecting on success in trauma research: experiences from the SGCNS and SIR studies. BMJ Mil Health 2020; 167:118-121. [PMID: 32487676 PMCID: PMC8005801 DOI: 10.1136/bmjmilitary-2020-001467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
The inclusion of British Service Personnel (SP) lacking capacity into research studies from the point of injury through to medium-term rehabilitation had not previously been undertaken until work to support operations in Afghanistan (2001-2014). The Surgeon General's Casualty Nutrition Study and the Steroids and Immunity from Injury through to Rehabilitation Study sought to address the nutrition, endocrine and immune responses in a military patient cohort. A fundamental part of research is to feedback to patients, their relatives and ward staff on data collection and outcomes, and how future research may be improved to better support both injured SP and trauma patients in the UK. This paper will provide an experiential view on the delivery, operations and infrastructure requirements that should be considered when developing military research at a role-3 facility, before, during and after a study.
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Affiliation(s)
- Conor Bentley
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK .,Applied Physiology Department, Institute of Naval Medicine, Gosport, Hampshire, UK
| | - L Cooper
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - M Foster
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.,Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - J Fallowfield
- Applied Physiology Department, Institute of Naval Medicine, Gosport, Hampshire, UK
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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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Govender R, Smith CH, Barratt H, Gardner B, Taylor SA. SIP SMART: a parallel group randomised feasibility trial of a tailored pre-treatment swallowing intervention package compared with usual care for patients with head and neck cancer. BMC Cancer 2020; 20:360. [PMID: 32349693 PMCID: PMC7191731 DOI: 10.1186/s12885-020-06877-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dysphagia or difficulty in swallowing affects quality of life for most patients with head and neck cancer. SIP SMART - [Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training] aims to improve post-treatment swallowing outcomes through a targeted and tailored pre-treatment intervention. This feasibility study assessed 1) recruitment and retention, 2) patient acceptability of randomisation and participation, 3) patient adherence, and 4) sought to identify a suitable primary outcome for a definitive trial, including sample size estimation. METHODS This two-arm parallel group non-blinded randomised feasibility trial took place within a head and neck centre at a teaching hospital in London, UK. Patients newly diagnosed with stage III/IV head and neck cancer were recruited and underwent 6-month follow-up. Patients were randomised to SIP-SMART or usual care via an online web-based system. SIP SMART comprised two 45-min consultations including a baseline clinical and instrumental swallowing assessment, relevant educational information, targeted swallowing exercises, and specific behaviour change strategies to increase exercise adherence. Usual care comprised a single session including a baseline clinical assessment and generic information about the likely impact of treatment on swallowing. RESULTS A total of 106 patients were identified at pre-screening, 70 were assessed for eligibility. Twenty-six patients did not meet eligibility criteria [0.37, 95% CI 0.27 to 0.49]. Five of 44 [0.11, 95% CI 0.05 to 0.24] eligible patients were not approached by researchers during clinic. Seven [0.18, 95% CI 0.08 to 0.33] of the 39 approached declined participation. Target recruitment (32 consented patients) was achieved within the timeframe. At 6-months 29/32 [0.91, 95% CI 0.76 to 0.97] patients remained in the trial. Acceptability of randomisation and participation in the intervention was favourable, and adherence to the exercises exceeded the pre-defined 35% minimum criterion. The MD Anderson Dysphagia Inventory swallow related quality of life measure was selected as the most suitable primary outcome for sample size estimation. No adverse effects arose from the intervention, or study participation. CONCLUSIONS A definitive trial of the SIP SMART intervention compared to usual care is feasible and can be undertaken with patients with head and neck cancer treated within the NHS. TRIAL REGISTRATION ISRCTN40215425, registered retrospectively.
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Affiliation(s)
- Roganie Govender
- Research Department of Behavioural Science & Health, University College London and Head & Neck Cancer Centre, University College London Hospital, 250 Euston Road, Ground floor Central, London, NW1 2PQ UK
| | - Christina H. Smith
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Helen Barratt
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Stuart A. Taylor
- Centre for Medical Imaging, University College London, London, UK
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40
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Gayet-Ageron A, Rudaz S, Perneger T. Study design factors influencing patients' willingness to participate in clinical research: a randomised vignette-based study. BMC Med Res Methodol 2020; 20:93. [PMID: 32336266 PMCID: PMC7183682 DOI: 10.1186/s12874-020-00979-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 04/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background High patient participation in clinical research reduces selection bias and ensures the generalizability of study findings. We explored study-related factors that may influence patients’ willingness to participate in research. Methods We submitted by mail two vignettes that described clinical research studies – a drug trial and a diagnostic study – to patients recently discharged from hospital and assessed their willingness to participate. We used a factorial design to randomly allocate three study attributes per vignette: in the drug trial, presumed superiority of new drug versus equipoise, public versus industry funding, and random versus non-random treatment allocation; in the diagnostic study, common versus rare disease, genetic versus protein analysis, and automatic reporting of results versus reporting on request. Results Of 2600 patients contacted, 1140 (44%) participated. Globally, willingness to participate in a drug trial was lower than in a diagnostic study (44.8% vs. 76.2%; P < 0.001). In the drug trial, participation was significantly higher when the new drug was presented as presumably better than the old (vs. equipoise) and when the study was funded by public sources (vs. industry), but was not affected by the allocation method. None of the factors tested in the diagnostic study was associated with participation. Conclusions Patients were more likely to participate in a hypothetical observational diagnostic study than in a hypothetical drug trial. Participation in the trial was lower when clinical equipoise was expressed and when the trial was funded by industry. These results suggest that some features of study design can influence participation.
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Affiliation(s)
- Angèle Gayet-Ageron
- Division of Clinical Epidemiology and Department of health and community medicine, Geneva University Hospitals and Faculty of Medicine, 6 Rue Gabrielle Perret-Gentil, 1211, 14, Geneva, Switzerland.
| | - Sandrine Rudaz
- Division of Clinical Epidemiology and Department of health and community medicine, Geneva University Hospitals and Faculty of Medicine, 6 Rue Gabrielle Perret-Gentil, 1211, 14, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology and Department of health and community medicine, Geneva University Hospitals and Faculty of Medicine, 6 Rue Gabrielle Perret-Gentil, 1211, 14, Geneva, Switzerland
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Bell JAH, Kelly MT, Gelmon K, Chi K, Ho A, Rodney P, Balneaves LG. Gatekeeping in cancer clinical trials in Canada: The ethics of recruiting the "ideal" patient. Cancer Med 2020; 9:4107-4113. [PMID: 32314549 PMCID: PMC7300392 DOI: 10.1002/cam4.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 01/11/2023] Open
Abstract
Background Perspectives of clinical trial (CT) personnel on accrual to oncology CTs are relatively absent from the literature. This study explores CT personnel's experience recruiting patients to oncology CTs. Methods A qualitative study design was utilized. In‐depth, individual interviews with 12 oncology CT personnel were conducted, including six CT nurses and six physician‐investigators. Interviews were digitally recorded and transcribed verbatim. Data were subjected to thematic and ethical analysis to identify key concepts and themes. Results CT personnel reported considering two ethical commitments in CT recruitment: maintaining trial integrity and ensuring patient autonomy through obtaining informed consent. The process of gatekeeping emerged as a way to navigate these ethical commitments during CT accrual. Gatekeeping was influenced by: (a) perceptions of patients’ personal suitability for a trial, and (b) healthcare resources and infrastructure. CT personnel's discernment of personal suitability was influenced by patients’ cognitive and mental health status, language and cultural background, geographic location, family support, and disease status. Three structural factors impacted gatekeeping: complexity of CTs, consent process, and time limitations in the healthcare system. CT personnel experienced most factors as constraints to accrual and gaining patients’ informed consent. Conclusion CT personnel discussed navigating ethical challenges in CT recruitment by offering enrollment to specific patient populations, exacerbating other ethical tensions. Systems‐level strategies are needed to address barriers to ethical CT recruitment. Future research should investigate the role of policies and/or tools (eg, decision aids) to support patients and CT personnel's discussions about CT participation, promote more ethical recruitment, and potentially increase accrual.
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Affiliation(s)
- Jennifer A H Bell
- University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Karen Gelmon
- University of British Columbia, Vancouver, BC, Canada
| | - Kim Chi
- University of British Columbia, Vancouver, BC, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, BC, Canada.,University of California, Oakland, CA, USA.,Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
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Patient barriers to cancer clinical trial participation and navigator activities to assist. Adv Cancer Res 2020; 146:139-166. [PMID: 32241387 DOI: 10.1016/bs.acr.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical research is vital to the discovery of new cancer treatments that can enhance health and prolong life for cancer patients, but breakthroughs in cancer treatment are limited by challenges recruiting patients into cancer clinical trials (CT). Only 3-5% of cancer patients in the United States participate in a cancer CT and there are disparities in CT participation by age, race and gender. Strategies such as patient navigation, which is designed to provide patients with education and practical support, may help to overcome challenges of CT recruitment. The current study evaluated an intervention in which lay navigators were utilized to provide patient education and practical support for helping patients overcome barriers to CT participation and related clinical care. A patient barrier checklist was utilized to record patient barriers to CT participation and care, actions taken by navigators to assist patients with these barriers, and whether or not these barriers could be overcome. Forty patients received patient navigation services. The most common barriers faced by navigated patients were fear (n=9), issues communicating with medical personnel (n=9), insurance issues (n=8), transportation difficulties (n=6) and perceptions about providers and treatment (n=4). The most common activities undertaken by navigators were making referrals and contacts on behalf of patients (e.g., support services, family, clinicians; n=25). Navigators also made arrangement for transportation, financial, medication and equipment services for patients (n=11) and proactively navigated patients (n=8). Barriers that were not overcome for two or more patients included insurance issues, lack of temporary housing resources for patients in treatment and assistance with household bills. The wide array of patient barriers to CT participation and navigator assistance documented in this study supports the CT navigator role in facilitating quality care.
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Nyamaruze P, Govender K. "I like the way I am, but I feel like I could get a little bit bigger": Perceptions of body image among adolescents and youth living with HIV in Durban, South Africa. PLoS One 2020; 15:e0227583. [PMID: 31923249 PMCID: PMC6953798 DOI: 10.1371/journal.pone.0227583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/20/2019] [Indexed: 12/05/2022] Open
Abstract
Body image concerns are common among people living with HIV (PLHIV). Research into how young people living with HIV (YPLHIV) experience and make sense of feared or actual body changes is limited, yet these changes have emotional, psychological and interpersonal implications for young people who associate physical attractiveness with social desirability. The current study examined the subjective perceptions of body appearance and coping mechanisms among a sample of YPLHIV in Durban, South Africa. An interpretive qualitative inquiry was adopted to understand their lived experiences in relation to their body image and body satisfaction. In-depth interviews were conducted with 18 YPLHIV (15–24 years). Findings indicate physical and psychosocial effects of living with HIV among young people including weight loss, skin sores, body dissatisfaction, loss of self-esteem and social withdrawal. The study builds on previous research suggesting that PLHIV may experience a discrepancy between their actual self and ideal self. Enhancing existing coping mechanisms such as religious beliefs, support networks and physical exercises among YPLHIV can counter the physical and psychosocial effects of living with HIV and improve well-being. Body image concerns should be acknowledged when addressing HIV-related health in both health and family settings.
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Affiliation(s)
- Patrick Nyamaruze
- The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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Feustel AC, MacPherson A, Fergusson DA, Kieburtz K, Kimmelman J. Risks and benefits of unapproved disease-modifying treatments for neurodegenerative disease. Neurology 2020; 94:e1-e14. [PMID: 31792092 PMCID: PMC7011691 DOI: 10.1212/wnl.0000000000008699] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine whether patients randomized to unapproved, disease-modifying interventions in neurodegenerative disease trials have better outcomes than patients randomized to placebo by performing a systematic review and meta-analysis of risk and benefit experienced by patients in randomized placebo-controlled trials testing investigational treatments for Alzheimer disease, Parkinson disease, Huntington disease, or amyotrophic lateral sclerosis (ALS). METHODS We searched MEDLINE, Embase, and ClinicalTrials.gov for results of randomized trials testing non-Food and Drug Administration-approved, putatively disease-modifying interventions from January 2005 to May 2018. Trial characteristics were double-extracted. Coprimary endpoints were the treatment advantage over placebo on efficacy (standardized mean difference in outcomes) and safety (risk ratios of serious adverse events and withdrawals due to adverse events), calculated with random effects meta-analyses. The study was registered on PROSPERO (CRD42018103798). RESULTS We included 113 trials (n = 39,875 patients). There was no significant efficacy advantage associated with assignment to putatively disease-modifying interventions compared to placebo for Alzheimer disease (standardized mean difference [SMD] -0.03, 95% confidence interval [CI] -0.07 to 0.01), Parkinson disease (SMD -0.09, 95% CI -0.32 to 0.15), ALS (SMD 0.02, 95% CI -0.25 to 0.30), or Huntington disease (0.02, 95% CI -0.27 to 0.31). Patients with Alzheimer disease assigned to active treatment were at higher risk of experiencing serious adverse events (risk ratio [RR] 1.15, 95% CI 1.04-1.27) and withdrawals due to adverse events (RR 1.44, 95% CI 1.21-1.70). CONCLUSIONS Assignment to active treatment was not beneficial for any of the indications examined and may have been slightly disadvantageous for patients with Alzheimer disease. Our findings suggest that patients with neurodegenerative diseases are not, on the whole, harmed by assignment to placebo when participating in trials.
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Affiliation(s)
- Aden C Feustel
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Amanda MacPherson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Dean A Fergusson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Karl Kieburtz
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Jonathan Kimmelman
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY.
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Hwangbo Y, Son GM, Kim KH, Kwon MS, Kim KH. Colorectal cancer survivors’ willingness to participate in a hypothetical clinical trial of Korean medicine: A cross-sectional study. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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46
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Ecarnot F, Meunier-Beillard N, Quenot JP, Meneveau N. Factors associated with refusal or acceptance of older patients (≥ 65 years) to provide consent to participate in clinical research in cardiology: a qualitative study. Aging Clin Exp Res 2020; 32:133-140. [PMID: 30903598 DOI: 10.1007/s40520-019-01172-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical research is an essential step in the successful translation of knowledge from basic research into concrete clinical applications, yet many people are reluctant to provide consent when actually approached to actively participate in clinical trials. AIMS We investigated the factors that influence older patient's (≥ 65 years) decisions to accept or refuse to participate in a prospective randomized clinical trial in secondary prevention after acute coronary syndrome. METHODS Qualitative approach based on individual semi-structured interviews with patients who were approached for consent to participate in a currently ongoing clinical trial was adopted. Patients were interviewed after the consent process (8 accepted; 8 refused the trial). Interviews were analysed using grounded theory methodology. RESULTS Sixteen patients aged ≥ 65 years participated. The main concept to emerge from these interviews is that the actual trial itself does not appear to be the primary determinant in the decision to participate in clinical research. Rather, patients' decisions to participate (or not) in clinical research appear to be primarily determined by their capacity to deal with the current health event that has disrupted their life, and by their available mental and physical resources. DISCUSSION AND CONCLUSION Older patients display varying levels of engagement in their own health, ranging from low engagement with high trust in the medical profession, to high engagement mirrored by distrust of the medical profession. Structural conditions, such as personal benefit from trial participation, or logistic barriers to participation, seem to affect both accepters and refusers in the same manner.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France.
| | - Nicolas Meunier-Beillard
- Unité de Soutien Méthodologique à la Recherche - Délégation à la Recherche Clinique et à l'Innovation, François Mitterand University Hospital, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France
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Lee MK, Suh SR. Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2019; 45:217-236. [PMID: 29466347 DOI: 10.1188/18.onf.217-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of peer-led supportive interventions for patients with cancer.
. LITERATURE SEARCH Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
. DATA EVALUATION A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
. SYNTHESIS The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors.
. IMPLICATIONS FOR RESEARCH The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.
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Gentry KR, Arnup SJ, Disma N, Dorris L, de Graaff JC, Hunyady A, Morton NS, Withington DE, McCann ME, Davidson AJ, Lynn AM. Enrollment challenges in multicenter, international studies: The example of the GAS trial. Paediatr Anaesth 2019; 29:51-58. [PMID: 30375133 DOI: 10.1111/pan.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Randomized trials are important for generating high-quality evidence, but are perceived as difficult to perform in the pediatric population. Thus far there has been poor characterization of the barriers to conducting trials involving children, and the variation in these barriers between countries remains undescribed. The General Anesthesia compared to Spinal anesthesia (GAS) trial, conducted in seven countries between 2007 and 2013, provides an opportunity to explore these issues. METHODS We undertook a descriptive analysis to evaluate the reasons for variation in enrollment between countries in the GAS trial, looking specifically at the number of potential subjects screened, and the subsequent application of four exclusion criteria that were applied in a hierarchical order. RESULTS A total of 4023 patients were screened by 28 centers in seven countries. Australia and the USA screened the most subjects, accounting for 84% of all potential trial participants. The percentage of subjects eliminated from the screened pool by each exclusion criterion varied between countries. Exclusion due to a predefined condition (H1) eliminated only 5% of potential subjects in Italy and the UK, but 37% in Canada. Exclusions due to a contraindication or a physician's refusal most impacted enrollment in Australia and the USA. The patient being "too large for spinal anesthesia" was the most commonly cited by anesthetists who refused to enroll a patient (64% of anesthetist refusals). The majority of surgeon refusals came from the USA, where surgeons preferred the patient to receive a general anesthetic. The percentage of approached parents refusing to consent ranged from a low of 3% in Italy to a high of 70% in the USA and Netherlands. The most frequently cited reason for parent refusal in all countries was a preference for general anesthesia (median: 43%, range: 32%-67%). However, a sizeable proportion of parents in all countries had a contrasting preference for spinal anesthesia (median: 25%, range: 13%-31%), and 23% of U.S. parents expressed concern about randomization. CONCLUSION The GAS trial highlights enrollment challenges that can occur when conducting multicenter, international, pediatric studies. Investigators planning future trials should be aware of potential differences in screening processes across countries, and that exclusions by anesthetists and surgeons may vary in reason, in frequency, and by country. Furthermore, investigators should be aware that the U.S. centers encountered particularly high surgeon and parental refusal rates and that U.S. parents were uniquely concerned about randomization. Planning trials that address these difficulties should increase the likelihood of successfully recruiting subjects in pediatric trials.
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Affiliation(s)
- Katherine R Gentry
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Sarah J Arnup
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicola Disma
- Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Liam Dorris
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Jurgen C de Graaff
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Anesthesia, Erasmus MC Sophia's Children Hospital Rotterdam, Rotterdam, The Netherlands
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Neil S Morton
- Department of Anaesthesia, Royal Hospital for Children, Glasgow, UK
| | | | - Mary Ellen McCann
- Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Andrew J Davidson
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne M Lynn
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
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Peng W, Morgan SE, Mao B, McFarlane SJ, Occa A, Grinfeder G, Byrne MM. Ready to Make A Decision: A Model of Informational Aids to Improve Informed Participation in Clinical Trial Research. JOURNAL OF HEALTH COMMUNICATION 2019; 24:865-877. [PMID: 31663824 PMCID: PMC9617566 DOI: 10.1080/10810730.2019.1680773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Enrollment rates for cancer clinical trials remain low, affecting the generalizability of new treatments. Research shows that many patients face significant challenges in understanding basic clinical trial vocabulary and making informed decisions about participation. Informational aids (IA) are developed to address these challenges and support decision making of cancer clinical trial participation. The present study proposed and tested a structural path model to explain the efficacy of three (i.e., interactive, non-interactive, non-cancer control) IAs. The results revealed that clinical trial participation intention was associated with attitudes and social constructs (i.e., social norm, social sharing, and cues to action). Ease of use, rather than knowledge, was the primary communication feature of IA that influenced the outcome variables. The path relations linking messages features, mediators, and outcome variables were different across all three IAs. The results therefore provide theoretical and practical implications for the use and development of IAs to support clinical trial accrual.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida
| | - Susan E. Morgan
- School of Communication, University of Miami, Coral Gables, Florida
| | - Bingjing Mao
- School of Communication, University of Miami, Coral Gables, Florida
| | | | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky
| | - Gilles Grinfeder
- School of Communication, University of Miami, Coral Gables, Florida
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Patients' reasoning regarding the decision to participate in clinical cancer trials: an interview study. Trials 2018; 19:528. [PMID: 30268150 PMCID: PMC6162882 DOI: 10.1186/s13063-018-2916-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinical cancer trials are crucial for the implementation of new treatments in the clinical setting, but it is equally crucial that patients are given the opportunity to make a well-informed decision about participation. The inclusion process is complex, including both oral and written information about the trial. The process of patients' decision-making regarding clinical cancer trials has not yet been sufficiently studied. This interview study aims to explore the process of patients' reasoning regarding the decision to participate in a clinical cancer trial. METHODS The study is based on 27 individual face-to-face interviews with patients who had decided to participate in a clinical cancer trial. The interviews were audio-recorded and transcribed verbatim and then analysed using inductive content analysis. RESULTS Content analysis revealed 17 subthemes grouped into five themes: (1) an unhesitating decision to participate; (2) a decision based on flimsy grounds and guided by emotion; (3) feeling safe and secure with my decision; (4) faced with a choice versus what choice do I have? and (5) hoping for help while helping others. The decision to participate in a clinical cancer trial was often immediate and guided by emotions, based on a trusting relationship with healthcare personnel rather than on careful reading of written information. Palliative patients, in particular, sometimes had unrealistic beliefs about the effectiveness of the trial treatment. CONCLUSIONS It is vital that the decision to participate in a clinical cancer trial is preceded by an honest dialogue about possible positive and negative effects of the trial treatments, including other options such as supportive care in the palliative setting. Our findings also raise the questions of how important written information is for the decision-making process and also whether genuine informed consent is possible. To reach a higher degree of informed consent, it is most important that the oral information is given in a thorough and unbiased manner.
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