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Novak LA, Belsher BE, Freed MC, McCutchan PK, Liu X, Evatt DP, Tanielian T, Bray RM, Engel CC. Impact of financial reimbursement on retention rates in military clinical trial research: A natural experiment within a multi-site randomized effectiveness trial with active duty service members. Contemp Clin Trials Commun 2019; 15:100353. [PMID: 31032460 PMCID: PMC6477623 DOI: 10.1016/j.conctc.2019.100353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/21/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Achieving adequate retention rates in clinical trials is essential to ensuring meaningful results. Although financial reimbursement is an effective strategy to increase participant retention, current policies restrict the use of federal funds to reimburse U.S. active duty Service members for research participation. It is unknown whether permitting financial reimbursement among this population would improve trial retention rates. A recent randomized effectiveness trial received approval to provide reimbursement to Service member participants several months after recruitment began, creating a natural experiment to study the effects of financial reimbursement on retention. Materials and methods Active duty Service members recruited from six U.S. military treatment facilities (N = 666) were enrolled in a collaborative care study and completed assessments at baseline, three-, six-, and 12-months. Data on study assessment completion rates at three- and six-months were analyzed using the mixed-effects binary logit model to determine the probabilities of completing assessments based on reimbursement status. Results Participants who received reimbursement were significantly more likely to complete study assessments at both time-points than participants who did not receive reimbursement (p < 0.01). Survey completion was 5% and 4% greater among participants offered reimbursement at three- and six-month time-points, respectively. Conclusion Results suggest that providing Service members with reimbursement for research participation is associated with modest increases in retention rates in clinical trials. Findings provide useful insight for researchers, funding agencies, and policy-makers in considering retention strategies to maximize the value and impact of military research.
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Affiliation(s)
- Laura A. Novak
- Psychological Health Center of Excellence (formerly Deployment Health Clinical Center), Research and Development Directorate, Defense Health Agency, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA, 22041, USA
- Corresponding author. Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Bradley E. Belsher
- Psychological Health Center of Excellence (formerly Deployment Health Clinical Center), Research and Development Directorate, Defense Health Agency, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA, 22041, USA
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Michael C. Freed
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
- National Institute of Mental Health/NIH, BG NSC RM 7144 MSC 9629, 6001 Executive Blvd., Rockville, MD, 20892-9629, USA
| | | | - Xian Liu
- Psychological Health Center of Excellence (formerly Deployment Health Clinical Center), Research and Development Directorate, Defense Health Agency, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA, 22041, USA
| | - Daniel P. Evatt
- Psychological Health Center of Excellence (formerly Deployment Health Clinical Center), Research and Development Directorate, Defense Health Agency, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA, 22041, USA
| | - Terri Tanielian
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Robert M. Bray
- RTI International (Retired), 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709, USA
| | - Charles C. Engel
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA
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Petrova M, Barclay S. Research approvals iceberg: how a 'low-key' study in England needed 89 professionals to approve it and how we can do better. BMC Med Ethics 2019; 20:7. [PMID: 30678668 PMCID: PMC6346542 DOI: 10.1186/s12910-018-0339-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The red tape and delays around research ethics and governance approvals frequently frustrate researchers yet, as the lesser of two evils, are largely accepted as unavoidable. Here we quantify aspects of the research ethics and governance approvals for one interview- and questionnaire-based study conducted in England which used the National Health Service (NHS) procedures and the electronic Integrated Research Application System (IRAS). We demonstrate the enormous impact of existing approvals processes on costs of studies, including opportunity costs to focus on the substantive research, and suggest directions for radical system change. MAIN TEXT We have recorded 491 exchanges with 89 individuals involved in research ethics and governance approvals, generating 193 pages of email text excluding attachments. These are conservative estimates (e.g. only records of the research associate were used). The exchanges were conducted outside IRAS, expected to be the platform where all necessary documents are provided and questions addressed. Importantly, the figures exclude the actual work of preparing the ethics documentation (such as the ethics application, information sheets and consent forms). We propose six areas of work to enable system change: 1. Support the development of a broad range of customised research ethics and governance templates to complement generic, typically clinical trials orientated, ones; 2. Develop more sophisticated and flexible frameworks for study classification; 3. Link with associated processes for assessment, feedback, monitoring and reporting, such as ones involving funders and patient and public involvement groups; 4. Invest in a new generation IT infrastructure; 5. Enhance system capacity through increasing online reviewer participation and training; and 6. Encourage researchers to quantify the approvals processes for their studies. CONCLUSION Ethics and governance approvals are burdensome for historical reasons and not because of the nature of the task. There are many opportunities to improve their efficiency and analytic depth in an age of innovation, increased connectivity and distributed working. If we continue to work under current systems, we are perpetuating, paradoxically, an unethical system of research approvals by virtue of its wastefulness and impoverished ethical debate.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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April MD, April CW, Schauer SG, Maddry JK, Sessions DJ, Davis WT, Ng PC, Oliver J, Delorenzo RA. Optimizing Military Human Subjects Protection and Research Productivity: The Role of Institutional Memory. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:43-45. [PMID: 27366849 DOI: 10.1080/15265161.2016.1187222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Michael D April
- a San Antonio Uniformed Services Health Education Consortium
| | | | - Steven G Schauer
- c San Antonio Uniformed Services Health Education Consortium and United States Army Institute of Surgical Research
| | - Joseph K Maddry
- c San Antonio Uniformed Services Health Education Consortium and United States Army Institute of Surgical Research
| | | | - W Tyler Davis
- a San Antonio Uniformed Services Health Education Consortium
| | - Patrick C Ng
- a San Antonio Uniformed Services Health Education Consortium
| | - Joshua Oliver
- a San Antonio Uniformed Services Health Education Consortium
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