Clinical research in paediatric oncology and the role of the research nurse in the UK

Infirmière de recherche clinique en oncologie : revue exploratoire

En ce 21e siècle, le cancer est une maladie qui suscite particulièrement l’attention en raison de sa complexité ainsi que des impacts physiques, émotionnels et financiers sur notre vie. L’attention portée à la recherche et les investissements dans le traitement contre le cancer en font la maladie la plus étudiée dans les essais cliniques à l’échelle mondiale. Les infirmières de recherche clinique font partie de l’équipe de recherche en oncologie et sont un élément fondamental de réussite des essais. Leurs relations directes avec les participants d’une étude de recherche sont essentielles pour les activités des essais cliniques en première ligne. De façon générale, l’afflux et la complexité des essais cliniques en oncologie ont transformé la pratique infirmière en oncologie et ont mené à la création de la sous-spécialité unique qu’est l’infirmière de recherche clinique en oncologie. La présente revue exploratoire s’est penchée sur le rôle et la pratique futurs de l’infirmière de recherche clinique.

Oncology clinical trials nursing: A scoping review

In the 21st century, cancer is a disease that captures much of our attention for its complexity, and its physical, emotional, and financial impacts on one's life. Research attention and investment in cancer management has made it the most studied disease in clinical trials globally. Clinical trials nurses are part of the oncology research team and a fundamental factor in trial success. Their direct relationship with research subjects is the key connection in the operation of clinical trials at the front line. The influx and complexity of oncology clinical trials has transformed both oncology nursing practice in general and led to the development of the unique subspecialty of the oncology clinical trials nurse. This scoping review investigated the role and future practice of the clinical trials nurse.

Recognition and management of leukaemia in children

Leukaemia is the most common cancer in children. The presenting manifestations can be wide-ranging, from a relatively well child to life-threatening complications. Symptoms can be manifested in any of the bodily systems. Undertaking a thorough clinical assessment of the child, in addition to recognising and addressing parental concerns, is vital. Furthermore, recognising that children can commonly present with musculoskeletal or abdominal symptoms increases the diagnostic yield, thereby preventing missed or late diagnoses. Childhood cancer has a huge impact on the child and their family, both at diagnosis and in the long term; providing advice and signposting families to appropriate support groups is an important aspect of their management. Nurses play a vital role in managing children with cancers, starting from raising suspicion and identifying the child with leukaemia, ensuring that high-quality care is delivered throughout their treatment, managing complications, and providing support and information to children and their families. An illustrative case study is included to highlight some of the challenges that health professionals may encounter in their clinical practice.

Strengths and weaknesses of guideline approaches to safeguard voluntary informed consent of patients within a dependent relationship

BACKGROUND

It is thought that a dependent relationship between patients and physicians who enroll their own patients in research compromises voluntary informed consent. Therefore, several ethical guidelines for human subject research provide approaches to mitigate these compromises. Currently, these approaches have not been critically evaluated. In this article, we analyze the approaches of ethical guidelines to manage the influence of a dependent relationship between patients and physicians on voluntary informed consent and discuss the strengths and weaknesses of these approaches.

METHODS

We performed a review of international ethical guidance documents on human subject research, listed in the Oxford Textbook of Clinical Research Ethics and found through cross referencing. We also searched Global Ethics Observatory (GEObs) and the World Health Organization (WHO) website. Guidelines from all years were eligible for inclusion. The date last searched was December 2013.

DISCUSSION

We identified two basic guideline approaches: 1. A process approach, which focuses on the person who obtains informed consent, that is, an independent individual, such as a research nurse or counselor; and 2. A content approach, emphasizing the voluntary nature of participation. Both approaches are valuable, either because the influence of the physician may diminish or because it empowers patients to make voluntary decisions. However, the approaches also face challenges. First, research nurses are not always independent. Second, physician-investigators will be informed about decisions of their patients. Third, involvement of a counselor is sometimes unfeasible. Fourth, the right to withdraw may be difficult to act upon in a dependent relationship.

CONCLUSIONS

Current guideline approaches to protect voluntary informed consent within a dependent relationship are suboptimal. To prevent compromises to voluntary informed consent, consent should not only be obtained by an independent individual, but this person should also emphasize the voluntary nature of participation. At the same time, dependency as such does not imply undue influence. Sometimes the physician may be best qualified to provide information, for example, for a very specialized study. Still, the research nurse should obtain informed consent. In addition, patients should be able to consult a counselor, who attends the informed consent discussions and is concerned with their interests. Finally, both physicians and research nurses should disclose research interests.

Validating a measure to delineate the clinical trials nursing role in Italy

In Italy, the role of a nurse in cancer research is beginning to develop, but instruments developed to delineate the dimensions of the Italian clinical trials nursing role are lacking. This study aimed to translate into Italian the Clinical Trials Nursing Questionnaire (CTNQ) and assess its content validity, internal consistency, and stability reliability. Forward-backward translation and review by experts were performed to assess linguistic and content validation. Internal consistency reliability was computed using Cronbach alpha and by administering the translated CTNQ to a sample of 30 research nurses coming from different Italian districts. To determine the test-retest reliability, a copy of the questionnaire was given again to a subgroup of 10 research nurses. The pretest and posttest scores were compared using kappa coefficient. The comparison of the target language version with the original version allowed us to consider the translation of CTNQ as acceptable. The analyses revealed a Cronbach alpha coefficient of .98 for the frequency scale and .96 for the importance scale. The overall kappa coefficient was 0.98 for the frequency scale and 0.99 for the importance scale. The CTNQ is a valid and reliable instrument for the assessment of the research nurse's role in Italy.

Lessons learned as a research assistant studying ambulatory blood pressure in elderly Japanese stroke patients

The research assistant plays a critical part in research projects, yet there is little structured information about the role. The present paper describes the research assistant"s role and provides an example of the research assistant"s activities in nursing research. In this pilot study, 24 h ambulatory blood pressure monitoring was conducted on 15 elderly Japanese stroke patients in a hospital rehabilitation unit. The research assistant's involvement is described along the course of the study: pre-data collection; data collection and data processing. A research assistant needs to have good communication skills, a detail-oriented focus and an inquisitive nature.