1
|
Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. THE PATIENT 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
Collapse
Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| |
Collapse
|
2
|
Carroll P, Dervan A, McCarthy C, Woods I, Beirne C, Harte G, O’Flynn D, O’Connor C, McGuire T, Leahy LM, Gonzalez JG, Stasiewicz M, Maughan J, Quinlan J, Smith É, Moriarty F, O’Brien FJ, Flood M. The role of Patient and public involvement (PPI) in pre-clinical spinal cord research: An interview study. PLoS One 2024; 19:e0301626. [PMID: 38683786 PMCID: PMC11057720 DOI: 10.1371/journal.pone.0301626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient and public involvement in research (PPI) has many benefits including increasing relevance and impact. While using PPI in clinical research is now an established practice, the involvement of patients and the public in pre-clinical research, which takes place in a laboratory setting, has been less frequently described and presents specific challenges. This study aimed to explore the perspectives of seriously injured rugby players' who live with a spinal cord injury on PPI in pre-clinical research. METHODS Semi-structured interviews were conducted via telephone with 11 seriously injured rugby players living with spinal cord injury on the island of Ireland. A purposive sampling approach was used to identify participants. Selected individuals were invited to take part via gatekeeper in a charitable organisation that supports seriously injured rugby players. Interviews were transcribed verbatim and analysed thematically. FINDINGS Six themes were identified during analysis: 'appreciating potential benefits of PPI despite limited knowledge', 'the informed perspectives of people living with spinal cord injury can improve pre-clinical research relevance', 'making pre-clinical research more accessible reduces the potential for misunderstandings to occur', 'barriers to involvement include disinterest, accessibility issues, and fear of losing hope if results are negative', 'personal contact and dialogue helps people feel valued in pre-clinical research, and 'PPI can facilitate effective dissemination of pre-clinical research as desired by people living with spinal cord injury.' CONCLUSION People affected by spinal cord injury in this study desire further involvement in pre-clinical spinal cord injury research through dialogue and contact with researchers. Sharing experiences of spinal cord injury can form the basis of PPI for pre-clinical spinal cord injury research.
Collapse
Affiliation(s)
- Pádraig Carroll
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Adrian Dervan
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Ciarán McCarthy
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Ian Woods
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Cliff Beirne
- Faculty of Sports and Exercise Medicine (Royal College of Physicians in Ireland & RCSI), Dublin, Ireland
| | - Geoff Harte
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Dónal O’Flynn
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Cian O’Connor
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Tara McGuire
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Liam M. Leahy
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Javier Gutierrez Gonzalez
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Martyna Stasiewicz
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Jack Maughan
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - John Quinlan
- Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Éimear Smith
- National Rehabilitation Hospital, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fergal J. O’Brien
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
- PPI Ignite Network, Galway, Ireland
| |
Collapse
|
3
|
Evins A, Mayhew J, Cimms T, Whyte J, Vong K, Hribal E, Evans CJ, Grimm A. Glycogen storage disease type III: a mixed-methods study to assess the burden of disease. Ther Adv Endocrinol Metab 2024; 15:20420188231224233. [PMID: 38196773 PMCID: PMC10775738 DOI: 10.1177/20420188231224233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Background Glycogen storage disease type III (GSD III) is a rare inherited disorder that results from a glycogen debranching enzyme deficiency. Objectives The purpose of this research was to collect data on the signs, symptoms, and impacts of GSD III from the perspective of adult patients and caregivers of individuals with GSD III. Design Online survey and qualitative interviews. Methods Following institutional review board approval, adult patients and caregivers of children with GSD III were recruited through advocacy networks and clinical sites. If eligible, participants were consented, screened, and sent a survey and/or participated in a 60-min interview. The survey and interview included questions about family history, diagnosis, signs and symptoms, impacts, and management of GSD III. Conceptual models were developed following the analysis of results. Results In all, 29 adults and 46 caregivers completed the online survey and/or the interviews with 73 survey and 19 interview respondents. Adults and caregivers reported digestive, musculoskeletal, growth and physical appearance, and cardiac signs and symptoms. Liver conditions were reported by most respondents (83%). Adults and caregivers frequently reported impacts such as difficulty keeping up with peers (77%) and difficulty exercising/difficulty with physical activity (53%). Hypoglycemia was frequently reported in both adults and children, with more than half reporting hospitalizations due to hypoglycemia. Caregivers focused on hypoglycemia when reporting signs/symptoms that most interfere with their child's life and prevention of hypoglycemia as a desired outcome for an effective therapy. Adults most often reported muscle weakness as a top interfering symptom and the most important goal of a potential therapy. Impacts were also reported in activities of daily living, cognitive, emotional, work/school, and sleep domains. Conclusion Individuals with GSD III experience a broad spectrum of symptoms and disease impacts. There is an unmet need for therapies that improve metabolic control, reduce the burden of dietary management, reduce fatigue and liver problems, and improve muscle strength and function.
Collapse
Affiliation(s)
- Ayla Evins
- Ultragenyx Pharmaceutical Inc., 60 Leveroni Court, Novato, CA, 94949 USA
| | - Jill Mayhew
- Ultragenyx Pharmaceutical Inc., Novato, CA, USA
| | | | - Julie Whyte
- Endpoint Outcomes, A Lumanity Company, Boston, MA and Long Beach, CA, USA
| | - Kathy Vong
- Endpoint Outcomes, A Lumanity Company, Boston, MA and Long Beach, CA, USA
| | - Elizabeth Hribal
- Endpoint Outcomes, A Lumanity Company, Boston, MA and Long Beach, CA, USA
| | | | | |
Collapse
|
4
|
Furlong P, Dugar A, White M. Patient engagement in clinical trial design for rare neuromuscular disorders: impact on the DELIVER and ACHIEVE clinical trials. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:1. [PMID: 38167117 PMCID: PMC10759564 DOI: 10.1186/s40900-023-00535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Engaging individuals living with disease in drug development and regulatory processes leads to more thoughtful and sensitive trial designs, drives more informative and meaningful outcomes from clinical studies, and builds trust between the public, government, and industry stakeholders. This engagement is especially important in the case of rare diseases, where affected individuals and their families face many difficulties getting information, treatment, and support. Dyne Therapeutics is developing therapeutics for people with genetically-driven muscle diseases. During the development of potential treatments for Duchenne muscular dystrophy (DMD) and myotonic dystrophy type 1 (DM1), Dyne sought the opinions of individuals living with these diseases to inform its clinical trial design and to decrease the difficulties that participants and families might experience participating in them. METHODS Dyne engaged individuals and families living with DMD and DM1 as expert partners in its clinical development programs. Dyne convened panels of affected individuals and care partners/parents of individuals living with DMD (n = 8) or DM1 (n = 18). Workshops focused on how affected individuals and their families evaluate and select clinical trials for participation, the importance, quality, and burden associated with individual trial design elements, participation considerations such as site location and the study visit design, patient privacy, the suitability and scope of travel and participant support programs, and the accessibility of content in the informed consent (or assent) forms. Dyne also engaged the DMD Community Advisory Board (CAB) to collect feedback and advice on designing optimal and meaningful clinical trials and measuring relevant outcomes. RESULTS The issues most important to individuals living with DM1 and DMD regarding clinical trials were the ability to participate/access to the trial, perceptions of benefit and risk of trials and potential treatments, the flexibility of participation, clear communication from the sponsor, availability of information from trusted sources, and patient enrollment. In response to the patient advisory workshops and CAB feedback, Dyne refined clinical trial inclusion/exclusion criteria and clinic visit design, developed a travel service program to address the burden of clinical trial travel and enable long-distance and cross-border participation, planned for home visits when feasible, and allowed for adequate rest before clinic visit initiation and between assessments. Additionally, Dyne developed and implemented a transparent and consistent communications plan (including age-appropriate content) for trial participants and community members, and assessed and adjusted procedures to provide maximum participant comfort and lower anxiety, particularly with younger participants. CONCLUSIONS Ongoing communication with the Duchenne CAB and with DMD and DM1 patient advisory committee members allows Dyne to stay current with disease community perspectives and feedback on the needs and preferences of those affected and has provided valuable insights into the participant experience thereby helping Dyne initiate clinical trials that better meet the needs of affected individuals and their families.
Collapse
Affiliation(s)
- Patricia Furlong
- Parent Project Muscular Dystrophy, 1012 14th NW, Suite 500, Washington, DC, 20005, USA.
| | | | | |
Collapse
|
5
|
Chase DM, Shukla S, Courcy JD, Ellis H, Piercy J, Taylor-Whiteley T, Golembesky A, Wethington SL. The power of hope: Views of Ovarian Cancer patients on how maintenance therapy Affects their Lives (VOCAL). Future Oncol 2024; 20:83-94. [PMID: 37701998 DOI: 10.2217/fon-2023-0450] [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] [Indexed: 09/14/2023] Open
Abstract
Aim: To assess maintenance preference and trade-offs for patients with advanced epithelial ovarian cancer. Methods: Patients completed a time trade-off exercise ranking five maintenance approaches. Patients' preferred approach was compared with alternatives to determine the progression-free time they would trade off to remain on their preferred approach. Results: Of 152 patients (median age 53 years, 68% White), 56% chose one of four maintenance medications, mostly to feel proactive and 44% chose active surveillance. Compared with their preferred approach, patients were willing to trade a mean progression-free time before switching of 2.3 months for once-daily oral medications, 3.2 months for twice-daily oral medications, 5.5 months for intravenous infusions every 3 weeks (iv. q3), 6.1 months for active surveillance and 7.5 months for iv. q3 and twice-daily oral. Conclusion: Findings highlight the importance of patients' awareness of all maintenance approaches and involving them in the decision-making process.
Collapse
Affiliation(s)
- Dana M Chase
- Gynecologic Oncology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7383, USA
| | - Soham Shukla
- Value Evidence & Outcomes, GSK, Collegeville, PA, USA
| | | | | | | | | | - Amanda Golembesky
- Value Evidence & Outcomes - Oncology, GSK, Research Triangle, NC, USA
| | | |
Collapse
|
6
|
Mease C, Fermaglich LJ, Jackler K, Shermer S, Miller KL. Determining Commonalities in the Experiences of Patients with Rare Diseases: A Qualitative Analysis of US Food and Drug Administration Patient Engagement Sessions. THE PATIENT 2024; 17:25-37. [PMID: 37833521 DOI: 10.1007/s40271-023-00648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Rare diseases are estimated to affect more than one in ten Americans. However, most patients with a rare disease face significant emotional, physical, and social challenges. To better understand the burden of disease and unmet needs, the US Food and Drug Administration (FDA) conducts and supports multiple patient engagement platforms. We analyzed summaries from these discussions to identify commonalities among patients with disparate rare diseases, the results of which could inform priorities for cross-disease policies and medical product development. METHODS We conducted a qualitative analysis of patient engagement session summaries to investigate shared experiences across rare diseases. Cross-disease similarities were identified within four dimensions: product development/regulatory, clinical/physical, social/psychological, and economic/financial. Summaries from 29 rare diseases were included in our analyses. RESULTS Within the product development/regulatory dimension, we observed that patients and caregivers across rare diseases shared the desire for development of medical products that cured their disease or improved their overall quality of life. In the clinical/physical dimension, we found that patients had numerous common symptoms, including pain and fatigue. In the social/psychological dimension, we observed significant negative impact on mental health. Within the economic/financial dimension, patients and caregivers shared that disease burden caused significant financial hardships. CONCLUSION We found remarkable similarities among patients with rare diseases across all four dimensions. Our results indicate that, even among rare diseases with diverse etiologies, patients share numerous commonalties due to their diseases: a lack of effective treatment options, certain physical symptoms, mental health challenges, and financial concerns.
Collapse
Affiliation(s)
- Catherine Mease
- Office of Orphan Products Development, Office of the Commissioner, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
| | - Lewis J Fermaglich
- Office of Orphan Products Development, Office of the Commissioner, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Karen Jackler
- Office of the Center Director, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Shawn Shermer
- Patient Affairs Staff, Office of the Commissioner, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Kathleen L Miller
- Office of Orphan Products Development, Office of the Commissioner, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| |
Collapse
|
7
|
Davis S, Edwards T, Norcross L, Fehnel S, Beaudet A, Eckart M, Fastenau J. Use of the National Cancer Institute Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events to assess treatment tolerability in pulmonary arterial hypertension: qualitative patient research findings in current and former users of oral selexipag. J Patient Rep Outcomes 2023; 7:134. [PMID: 38108945 PMCID: PMC10728389 DOI: 10.1186/s41687-023-00673-w] [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: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Understanding patients' perspectives regarding drug tolerability, in addition to effectiveness, provides a complete picture of the patient experience and supports more informed therapeutic decision-making. The item library of the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was developed to measure patient-reported frequency, severity, and interference of adverse events (AEs) associated with cancer therapies. This qualitative interview study assessed the suitability of items selected from the PRO-CTCAE library for assessing tolerability of selexipag, a medication targeting the prostacyclin pathway for patients with pulmonary arterial hypertension (PAH). METHODS Two rounds of 10 qualitative, web-assisted telephone interviews following a semi-structured guide were conducted in individuals with recent experience taking oral selexipag for PAH. Each interview included concept elicitation to gather participants' perspectives on symptomatic AEs (type, frequency, severity, and interference) and cognitive debriefing of PRO-CTCAE items addressing the most frequently reported AEs of oral selexipag. RESULTS Interviews were conducted with 20 participants with PAH (mean [range] age 50 [24-68] years; 75% female; 85% in World Health Organization Functional Class II-III), comprising different races/ethnicities, levels of education, and employment status. Fifteen participants were currently treated with selexipag; five had taken selexipag for ≥ 6 months before discontinuing. The most frequently reported AEs included headache, jaw pain, and nausea (n = 15, 12, and 10 participants, respectively). Diarrhea and headache were identified as the most bothersome AEs by 5 and 4 participants, respectively. Some AEs were transitory (e.g., jaw pain); others were long-lasting (e.g., muscle pain). Based on findings from Round 1 interviews, a flushing item was added and the PRO-CTCAE general pain item was modified to be specific to jaw pain for testing in Round 2. Interview findings identified the following AEs as relevant to assess in a PAH clinical trial: nausea, vomiting, diarrhea, flushing, jaw pain, headache, aching muscles, and aching joints. CONCLUSIONS The PRO-CTCAE items selected in this study and the additional symptomatic AEs identified as patient-relevant have the potential to be included in assessments capturing the patient perspective on tolerability in future studies of selexipag and possibly other PAH therapies.
Collapse
Affiliation(s)
- Stacy Davis
- Janssen Global Services, LLC, Horsham, PA, USA.
| | | | | | - Sheri Fehnel
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Amélie Beaudet
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Marie Eckart
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | | |
Collapse
|
8
|
Wexler C, Maloba M, Sliefert M, Babu S, Maosa N, Maliski E, Nicolay Z, Were F, Mbithi Y, Mugendi G, Thomas G, Acharya H, Finocchario-Kessler S. Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study. BMC Health Serv Res 2023; 23:1103. [PMID: 37845699 PMCID: PMC10580521 DOI: 10.1186/s12913-023-10078-6] [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: 02/20/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Current infant antiretroviral therapy formulations pose barriers to daily adherence due to complex weight-based dosing, conspicuous preparation, and poor palatability. These adherence barriers jeopardize adherence, making patients vulnerable to virologic failure, development of drug resistance, and preventable mortality. Our team has previously established proof-of-principle for multi-drug oral dissolvable strips as alternative pediatric antiretroviral formulations with the potential to overcome these challenges and improve pediatric ART adherence and outcomes. The objective of this study was to assess caregiver and provider preferences for oral dissolvable strips and its packaging to inform its development. METHODS Guided by concepts of user-centered design, we conducted key informant interviews with 30 HIV care providers and focus group discussions targeting caregivers of children < 10 years of age living with HIV at 3 Kenyan hospitals. Key informant interviews and focus group discussions were audio recorded, translated/transcribed verbatim, and hand coded for a-priori and emergent themes. RESULTS A total of 30 providers and 72 caregivers (caring for 83 children, aged 5 months to 18 years) participated in the study. Caregivers and providers expressed a strong desire for an easier way to administer medication, especially among children too young to swallow tablets whole, and expressed enthusiasm around the idea of oral dissolvable strips. Key preferences included a pleasant taste; one strip per dose; small size with rapid dissolution; clear markings and instructions; and no special storage requirements. For packaging, stakeholders preferred individually wrapped strips within a dispenser. The individual packaging should be durable, waterproof, and easy to dispose of in communal spaces. They should also be easy to open, with clear indications where to open. The packaging holding the strips should be durable, re-usable, accommodating of various refill frequencies, and easy to use for children as young as 6. DISCUSSION The concept of oral dissolvable strips was highly acceptable to caregivers of children living with HIV and HIV care providers. By engaging stakeholders in an iterative design process starting from the early phases of design and development, we will maximize the likelihood of developing a product that is acceptable to the caregiver and infant, therefore leading to sustainable adherence.
Collapse
Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Michala Sliefert
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | | | | | | | - Gregory Thomas
- School of Architecture and Design, University of Kansas, Lawrence, KS, USA
| | - Harshdeep Acharya
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | |
Collapse
|
9
|
Stephenson D, Belfiore-Oshan R, Karten Y, Keavney J, Kwok DK, Martinez T, Montminy J, Müller MLTM, Romero K, Sivakumaran S. Transforming Drug Development for Neurological Disorders: Proceedings from a Multidisease Area Workshop. Neurotherapeutics 2023; 20:1682-1691. [PMID: 37823970 PMCID: PMC10684834 DOI: 10.1007/s13311-023-01440-x] [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] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
Neurological disorders represent some of the most challenging therapeutic areas for successful drug approvals. The escalating global burden of death and disability for such diseases represents a significant worldwide public health challenge, and the rate of failure of new therapies for chronic progressive disorders of the nervous system is higher relative to other non-neurological conditions. However, progress is emerging rapidly in advancing the drug development landscape in both rare and common neurodegenerative diseases. In October 2022, the Critical Path Institute (C-Path) and the US Food and Drug Administration (FDA) organized a Neuroscience Annual Workshop convening representatives from the drug development industry, academia, the patient community, government agencies, and regulatory agencies regarding the future development of tools and therapies for neurological disorders. This workshop focused on five chronic progressive diseases: Alzheimer's disease, Parkinson's disease, Huntington's disease, Duchenne muscular dystrophy, and inherited ataxias. This special conference report reviews the key points discussed during the three-day dynamic workshop, including shared learnings, and recommendations that promise to catalyze future advancement of novel therapies and drug development tools.
Collapse
|
10
|
Rasul E, Hallock R, Hellmann M, Konduros J, Pembroke L, LeCleir G, Malacan J, von Mackensen S. Gene Therapy in Hemophilia: A Transformational Patient Experience. J Patient Exp 2023; 10:23743735231193573. [PMID: 37663068 PMCID: PMC10472832 DOI: 10.1177/23743735231193573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact.
Collapse
Affiliation(s)
- Enayet Rasul
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Ryan Hallock
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Magnus Hellmann
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Jay Konduros
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Luke Pembroke
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | | | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Fischer R, Porter K, Donovan JM, Scavina MT, Armstrong N, Denger B, Hasham S, Peay H. A Mixed-Method Study Exploring Patient-Experienced and Caregiver-Reported Benefits and Side Effects of Corticosteroid Use in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023:JND221617. [PMID: 37182893 DOI: 10.3233/jnd-221617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Corticosteroids are recommended to all people with Duchenne as standard of care; experience data is important to guide corticosteroid decision making and as a comparator for new treatment options. OBJECTIVE This study assesses patient and caregiver-reported benefits and side effects from corticosteroids to treat Duchenne muscular dystrophy, their importance, and satisfaction. METHODS Using one-on-one interviews (n = 28) and an online survey (n = 236), parents and adults with Duchenne reported corticosteroid benefits and side effects rated as both experienced and important. RESULTS Benefits to breathing, heart function, arm strength, slowing progression of weakness, and getting around were rated as particularly important, regardless of ambulatory status. Important side effects included increased fracture risk, unwanted weight gain, and diabetes/prediabetes. Parents rated behavior issues and adults rated delayed puberty as having high importance. Being ambulatory was independently associated with reporting more net benefit (p = 0.02). For side effects, parent scores were significantly higher than adult score (p = 0.02). Corticosteroid type was not significant. Participants were, overall, satisfied with corticosteroids (means ranging from 6.2 to 7.7 on a scale of 0-10), with no significant differences based on corticosteroid type. CONCLUSIONS Overall, most participants were satisfied with the use of corticosteroids. While a range of side effects were rated as important and relatively common, individuals using corticosteroids and their caregivers indicate that benefits outweigh the side effects. Qualitative data indicate that high acceptability is influenced by lack of treatment alternatives. Patient experience data on use of corticosteroids in Duchenne may be relevant to drug development, regulatory assessment of new treatments, and to families making decisions about corticosteroid use.
Collapse
|
12
|
Sharma R, Ahmed S, Campagnari J, Huff W, Lloyd L. Embedding Patient-Centricity by Collaborating with Patients to Transform the Rare Disease Ecosystem. Pharmaceut Med 2023:10.1007/s40290-023-00474-y. [PMID: 37142887 DOI: 10.1007/s40290-023-00474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/06/2023]
Abstract
What is patient-centricity? In some contexts, it has been associated with targeting therapies based on biomarkers or enabling healthcare access. There has been a surge in patient-centricity publications, and in many cases for the biopharmaceutical industry, patient engagement is used to endorse pre-held assumptions at a specific moment in time. Rarely is patient engagement used to drive business decisions. Here we describe an innovative partnership between Alexion, AstraZeneca Rare Disease and patients that allowed a deeper understanding of the biopharmaceutical stakeholder ecosystem and an empathic understanding of each patient's and caregiver's lived experience. Alexion's decision to build patient-centricity frameworks resulted in the formation of two unique organisation design platforms: STAR (Solutions To Accelerate Results for patients) and LEAP (Learn, Evolve, Activate and deliver for Patients) Immersive Simulations. These interconnected programmes required cultural, global, and organisational shifts. STAR generates global patient insights that are embedded in drug candidate and product strategies while helping to establish enterprise foundational alignment and external stakeholder engagement plans. LEAP Immersive Simulations produce detailed country-level patient and stakeholder insights that contribute to an empathetic understanding of each patient's lived experience, support country medicine launches and provide ideas to have a positive impact along the patient journey. Combined, they deliver integrated, cross-functional insights, patient-centric decision making, an aligned patient journey, and 360° stakeholder activation. Throughout these processes, the patient is empowered to dictate their needs and validate the proposed solutions. This is not a patient engagement survey. This is a partnership where the patient co-authors strategies and solutions.
Collapse
Affiliation(s)
- Rohita Sharma
- Global Patient Insights and Solutions, Alexion, AstraZeneca Rare Disease, 1385 Craigleith Road, Oakville, Vaughan, Canada.
| | - Sumaira Ahmed
- Founder/Executive Director, The Sumaira Foundation, Boston, MA, USA
| | - Judy Campagnari
- Global Patient Insights and Solutions, Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Wendi Huff
- Vice President of Programs and Clinical Care, Myasthenia Gravis Foundation of America, Westborough, MA, USA
| | | |
Collapse
|
13
|
Oliveira R, Almeida IF. Patient-Centric Design of Topical Dermatological Medicines. Pharmaceuticals (Basel) 2023; 16:ph16040617. [PMID: 37111373 PMCID: PMC10144586 DOI: 10.3390/ph16040617] [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: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Topical treatments are essential approaches to skin diseases but are associated with poor adherence. Topical vehicles have the primary purpose of ensuring drug effectiveness (by modulating drug stability and delivery, as well as skin properties) but have a marked impact on treatment outcomes as they influence patient satisfaction and, consequently, adherence to topical treatments. There is also a wide variety of vehicles available for topical formulations, which can complicate the decisions of clinicians regarding the most appropriate treatments for specific skin disorders. One of the possible strategies to improve topical-treatment adherence is the implementation of patient-centric drug-product design. In this process, the patient's needs (e.g., those related to motor impairment), the needs associated with the disease (according to the skin lesions' characteristics), and the patient's preferences are taken into consideration and translated into a target product profile (TPP). Herein, an overview of topical vehicles and their properties is presented, along with a discussion of the patient-centric design of topical dermatological medicines and the proposal of TPPs for some of the most common skin diseases.
Collapse
Affiliation(s)
- Rita Oliveira
- FP-BHS-Biomedical and Health Sciences Research Unit, FFP-I3ID-Instituto de Investigação, Inovação e Desenvolvimento, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Rua Carlos da Maia 296, 4200-150 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, MedTech, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
| | - Isabel F Almeida
- UCIBIO-Applied Molecular Biosciences Unit, MedTech, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
| |
Collapse
|
14
|
Algorri M, Cauchon NS, Christian T, O'Connell C, Vaidya P. Patient-Centric Product Development: A Summary of Select Regulatory CMC and Device Considerations. J Pharm Sci 2023; 112:922-936. [PMID: 36739904 DOI: 10.1016/j.xphs.2023.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Patient-centric drug development describes the systematic approach to incorporating the patient's perspectives and preferences into the design, assessment, and production of a therapeutic product. While a patient centric approach can be applied at any stage of the drug development lifecycle, an integrated end-to-end strategy is often most effective to create an optimized product for the patient at the earliest possible timepoint. The importance of patient centricity is well recognized by health authorities and biopharmaceutical organizations which have established toolsets, guidances, and methodologies for incorporating patient input during the clinical stage of development. However, in addition to clinical research, there are other significant aspects of product development that profoundly impact the patient experience. Specifically, chemistry, manufacturing, and control (CMC) and device aspects must also be acknowledged and addressed as part of a cohesive patient-centric development strategy. This review explores current applications and regulatory considerations for patient-centric approaches across the product lifecycle, including R&D, early product development, clinical development, device and combination product development, and post-approval change management. Specific topics of discussion include the contributions of product modality, formulation, and devices to the patient experience; usage of the Quality Target Product Profile (QTPP) as a patient-centered design tool; and post-approval product optimization. Future advancements in regulatory data management and information exchange are also explored as potential enablers of patient engagement which support enhanced communication and interconnectivity between stakeholders. Multidisciplinary collaboration between patients, health authorities, health care providers, and the biopharmaceutical industry is ultimately necessary for ensuring that medicinal products, and their corresponding regulatory processes, take on a patient-first mindset that prioritizes patient needs, values, and preferences.
Collapse
Affiliation(s)
- Marquerita Algorri
- Department of Global Regulatory Affairs and Strategy - CMC, Amgen Inc, Thousand Oaks, CA 91320, USA
| | - Nina S Cauchon
- Department of Global Regulatory Affairs and Strategy - CMC, Amgen Inc, Thousand Oaks, CA 91320, USA.
| | | | - Chelsea O'Connell
- Department of Global Regulatory Affairs and Strategy - Global Regulatory and R&D Policy, Amgen Inc, Thousand Oaks, CA 91320, USA
| | - Pujita Vaidya
- Department of Global Regulatory Affairs and Strategy - Global Regulatory and R&D Policy, Amgen Inc, Thousand Oaks, CA 91320, USA
| |
Collapse
|
15
|
Zvonareva O. Patient engagement in drug development: configuring a new resource for generating innovation. CRITICAL PUBLIC HEALTH 2023. [DOI: 10.1080/09581596.2023.2188140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Olga Zvonareva
- Department of Health, Ethics and Society, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
16
|
Tal-Singer R, Miller BE, Rommes JM, Luttmann MA, Demaison C, Bradley Drummond M, Pasquale CB. The COPD Foundation's COPD360Net Initiative Approach to Patient-Centric Drug Development: A Case Study in Using Patient Surveys to Inform New Treatments for Viral Respiratory Infections. J Patient Exp 2023; 10:23743735231151554. [PMID: 36741822 PMCID: PMC9893385 DOI: 10.1177/23743735231151554] [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] [Indexed: 01/28/2023] Open
Abstract
Patient-centric drug development is crucial to creating treatments that address unmet patient needs but is often ignored. The COPD Foundation's COPD360Net® includes a multistakeholder approach for operationalizing patient-centric development of treatments where patients, caregivers, scientists, and clinicians review opportunities based on scientific merit, potential to address an unmet need, and feasibility of adoption. COPD360Net deploys large-scale online community surveys to review profiles of potential therapies based on those criteria. This approach was implemented to inform the development of an intranasal spray to prevent viral respiratory infections (VRIs), a major cause of exacerbations in people with chronic lung diseases. Insights included: Of the 376 respondents with COPD surveyed, frequent exacerbators reported strong interest in a new type of antiviral nasal spray to prevent VRI.Patient survey and advisory committee insights demonstrated that a pan antiviral nasal spray has potential high value to both clinicians and patients and informed the COPD360Net decision to partner on its development.Including patient perspectives from the outset can be conducted efficiently by mobilizing an engaged online patient community.
Collapse
Affiliation(s)
| | | | | | - Mark A Luttmann
- COPD Foundation, COPD360Net, Washington DC, USA,Cara B Pasquale, COPD Foundation, 3300
Ponce de Leon Blvd, Miami, FL 33134, USA.
| | | | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
17
|
Carroll P, Dervan A, Maher A, McCarthy C, Woods I, Kavanagh R, Beirne C, Harte G, O'Flynn D, O'Connor C, McGuire T, Leahy LM, Gonzalez JG, Stasiewicz M, Maughan J, Gouveia PJ, Murphy PJ, Quinlan J, Casey S, Holton A, Smith É, Moriarty F, O'Brien FJ, Flood M. Applying Patient and Public Involvement in preclinical research: A co-created scoping review. Health Expect 2022; 25:2680-2699. [PMID: 36217557 DOI: 10.1111/hex.13615] [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: 07/28/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient and Public Involvement (PPI) in research aims to improve the quality, relevance and appropriateness of research. PPI has an established role in clinical research where there is evidence of benefit, and where policymakers and funders place continued emphasis on its inclusion. However, for preclinical research, PPI has not yet achieved the same level of integration. As more researchers, including our team, aim to include PPI in preclinical research, the development of an evidence-based approach is important. Therefore, this scoping review aimed to identify and map studies where PPI has been used in preclinical research and develop principles that can be applied in other projects. METHODS A scoping review was conducted to search the literature in Medline (PubMed), EMBASE, CINAHL, PsycInfo and Web of Science Core Collection to identify applied examples of preclinical PPI. Two independent reviewers conducted study selection and data extraction separately. Data were extracted relating to PPI in terms of (i) rationale and aims, (ii) approach used, (iii) benefits and challenges, (iv) impact and evaluation and (v) learning opportunities for preclinical PPI. Findings were reviewed collaboratively by PPI contributors and the research team to identify principles that could be applied to other projects. RESULTS Nine studies were included in the final review with the majority of included studies reporting PPI to improve the relevance of their research, using approaches such as PPI advisory panels and workshops. Researchers report several benefits and challenges, although evidence of formal evaluation is limited. CONCLUSION Although currently there are few examples of preclinical research studies reporting empirical PPI activity, their findings may support those aiming to use PPI in preclinical research. Through collaborative analysis of the scoping review findings, several principles were developed that may be useful for other preclinical researchers. PATIENT OR PUBLIC CONTRIBUTION This study was conducted as part of a broader project aiming to develop an evidence base for preclinical PPI that draws on a 5-year preclinical research programme focused on the development of advanced biomaterials for spinal cord repair as a case study. A PPI Advisory Panel comprising seriously injured rugby players, clinicians, preclinical researchers and PPI facilitators collaborated as co-authors on the conceptualization, execution and writing of this review, including refining the findings into the set of principles reported here.
Collapse
Affiliation(s)
- Pádraig Carroll
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adrian Dervan
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anthony Maher
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ciarán McCarthy
- c/o Irish Rugby Football Union (IRFU) Charitable Trust, Dublin, Ireland
| | - Ian Woods
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Rachel Kavanagh
- Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Cliff Beirne
- Faculty of Sports and Exercise Medicines, RCSI University of Medicine and Health Sciences & Royal College of Physicians in Ireland, Dublin, Ireland
| | - Geoff Harte
- c/o Irish Rugby Football Union (IRFU) Charitable Trust, Dublin, Ireland
| | - Dónal O'Flynn
- c/o Irish Rugby Football Union (IRFU) Charitable Trust, Dublin, Ireland
| | - Cian O'Connor
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tara McGuire
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Liam M Leahy
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Javier Gutierrez Gonzalez
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Martyna Stasiewicz
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jack Maughan
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Pedro Jose Gouveia
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul J Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Sarah Casey
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alice Holton
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Éimear Smith
- National Rehabilitation Hospital, Dún Laoghaire, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Science Foundation Ireland (SFI) Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
18
|
Metz C, McCracken P, Hanmer J. Common Patient-Reported Outcomes Within the Food and Drug Administration Voice of the Patient Reports. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1743-1751. [PMID: 35577642 DOI: 10.1016/j.jval.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Proponents of disease-specific patient-reported outcome measurements (PROMs) often argue disease-agnostic measures do not adequately capture their patient population's experience. Patient-Reported Outcomes Measurement Information System (PROMIS) provides a disease-agnostic domain set that may adequately cover many diseases. This study seeks to investigate whether PROMIS's quality of life domain coverage can span patient-reported outcomes (PROs) elicited from patients across unrelated diseases. METHODS The Food and Drug Administration Voice of the Patient reports were an initiative to elevate patient voices regarding their condition and associated treatments. Two reviewers extracted patient-reported health-related (quality of life) domains from the reports and categorized them into PROMIS domains or non-PROMIS domains. Domain coverage was summarized for each report. Any extracted PROs not covered by PROMIS domains were placed in an "other" category and analyzed for common themes. RESULTS Across 26 reports, PROMIS covered 216 of 374 (70%) of the reports' PRO domains. The heritable bleeding disorders report had the highest coverage (82%). Human immunodeficiency virus had the lowest coverage (50%). The most common PROMIS domain, "ability to participate in social roles," appeared in 25 reports (96%). The most common domains not included in PROMIS were stigma, sensitivities, and sensory deficits as evident in 19 (73%), 18 (69%), and 18 reports (69%), respectively. If the top 3 unincluded domains were amended into PROMIS, the total domain coverage would increase to 84%. CONCLUSIONS PRO domains elicited in the Food and Drug Administration Voice of the Patient reports were widely captured by PROMIS, suggesting domains patients experience contain enough overlap to be recorded by appropriate PROMIS domains. PROMIS could increase its coverage by adding domains.
Collapse
Affiliation(s)
- Cameron Metz
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Polly McCracken
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
19
|
Hollin IL, Paskett J, Schuster ALR, Crossnohere NL, Bridges JFP. Best-Worst Scaling and the Prioritization of Objects in Health: A Systematic Review. PHARMACOECONOMICS 2022; 40:883-899. [PMID: 35838889 PMCID: PMC9363399 DOI: 10.1007/s40273-022-01167-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Best-worst scaling is a theory-driven method that can be used to prioritize objects in health. We sought to characterize all studies of best-worst scaling to prioritize objects in health, to assess trends of using best-worst scaling in prioritization over time, and to assess the relationship between a legacy measure of quality (PREFS) and a novel assessment of subjective quality and policy relevance. METHODS A systematic review identified studies published through to the end of 2021 that applied best-worst scaling to study priorities in health (PROSPERO CRD42020209745), updating a prior review published in 2016. The PubMed, EBSCOhost, Embase, Scopus, APA PsychInfo, Web of Science, and Google Scholar databases were used and were supplemented by a hand search. Data describing the application, development, design, administration/analysis, quality, and policy relevance were summarized and we tested for trends by comparing articles before and after 1 January, 2017. Multivariate statistics were then used to assess the relationships between PREFS, subjective quality, policy relevance, and other possible indicators. RESULTS From a total of 2826 unique papers identified, 165 best-worst scaling studies were included in this review. Applications of best-worst scaling to study priorities in health have continued to grow (p < 0.01) and are now used in all regions of the world, most often to study the priorities of patients/consumers (67%). Several key trends can be observed over time: increased use of pretesting (p < 0.05); increased use of online administration (p < 0.01), and decreased use of paper self-administered surveys (p = 0.02); increased use of heterogeneity analysis (p = 0.02); an increase in having a clearly stated purpose (p < 0.01); and a decrease in comparing respondents to non-respondents (p = 0.01). The average sample size has more than doubled, from 228 to 472 respondents, but formal sample size justifications remain low (5.3%) and unchanged over time (p = 0.68). While the average PREFS score remained unchanged at 3.1/5, both subjective quality and policy relevance trended up, but changes were not statistically significant (p = 0.06 and p = 0.13). Most of the variation in subjective quality was driven by PREFS (R2 = 0.42), but it was also positively assosciated with policy relevance, heterogeneity analysis, and using a balanced incomplete block design, and was negatively associated with not using developmental methods and an increasing sample size. CONCLUSIONS Using best-worst scaling to prioritize objects is now commonly used around the world to assess the priorities of patients and other stakeholders in health. Best practices are clearly emerging for best-worst scaling. Although legacy measures (PREFS) to measure study quality are reasonable, there may need to be new tools to assess both study quality and policy relevance.
Collapse
Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA
| | - Jonathan Paskett
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne L R Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.
| |
Collapse
|
20
|
Using qualitative methods to establish the clinically meaningful threshold for treatment success in alopecia areata. Qual Life Res 2022; 32:1319-1327. [PMID: 35821174 DOI: 10.1007/s11136-022-03170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Traditionally, appropriate anchors are used to investigate the amount of change on a clinician-reported outcome assessment that is meaningful to individual patients. However, novel qualitative methods involving input from disease state experts together with patients may better inform the individual improvement threshold for demonstrating the clinical benefit of new treatments. This study aimed to establish a clinically meaningful threshold for treatment success for the clinician-reported Severity of Alopecia Tool (SALT) score for patients with alopecia areata (AA). METHODS A purposive sample of 10 dermatologists expert in AA and 30 adult and adolescent patients with AA and a history of ≥ 50% scalp hair loss were recruited. Semi-structured interview questions explored the outcome that represented treatment success to clinicians and patients. Findings were analyzed using thematic methods to identify treatment success thresholds. RESULTS Both informant groups confirmed scalp hair amount as the outcome of priority. Most expert clinicians considered a static threshold of 80% (n = 5) or 75% (n = 3) of the scalp hair as a treatment success. Most patient responses ranged from 70 to 90% (median: 80% of the scalp hair). Subsequently, queried patients confirmed that achieving SALT score ≤ 20 with treatment would be a success, as reflected in the Alopecia Areata Investigator Global Assessment (AA-IGA™). The novel qualitative processes used to inform this meaningful threshold reflects a clinician-then-patient process for: (a) confirmation of the patient outcome of priority; and (b) clinician input on a preliminary treatment success level for independent understanding among patients. CONCLUSION This qualitative investigation of expert clinicians-then-patients with AA confirmed that achieving an amount of 80% or more scalp hair (SALT score ≤ 20) was an appropriate individual treatment success threshold indicating clinically meaningful improvement for patients with ≥ 50% scalp hair loss. A qualitative investigation of a quantifiable treatment success threshold is possible through a well-designed interview process with expert clinicians and the appropriate patient population.
Collapse
|
21
|
Turner EC, Gantman EC, Sampaio C, Sivakumaran S. Huntington's Disease Regulatory Science Consortium: Accelerating Medical Product Development. J Huntingtons Dis 2022; 11:97-104. [PMID: 35466945 DOI: 10.3233/jhd-220533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Huntington's disease (HD) is a devastating neurodegenerative disorder that urgently needs disease-modifying therapeutics. To this end, collaboration to standardize clinical research practices in the field and drive progress in addressing drug development challenges is paramount. At a meeting in 2017 organized by CHDI Foundation and the Critical Path Institute, stakeholders across the pharmaceutical industry, academia, regulatory agencies, and patient advocacy groups discussed the need for and potential impact of a consortium dedicated to HD regulatory science. Consequently, the Huntington's Disease Regulatory Science Consortium (HD-RSC) was formed, a precompetitive consortium that is dedicated to building a regulatory strategy to expedite the approval of HD therapeutics.
Collapse
|
22
|
Cole A, Richardson DR, Adapa K, Khasawneh A, Crossnohere N, Bridges JFP, Mazur L. Development of a patient-centered preference tool for patients with hematologic malignancies: protocol for a mixed methods study (Preprint). JMIR Res Protoc 2022; 11:e39586. [PMID: 35767340 PMCID: PMC9280452 DOI: 10.2196/39586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background The approval of novel therapies for patients diagnosed with hematologic malignancies have improved survival outcomes but increased the challenge of aligning chemotherapy choices with patient preferences. We previously developed paper versions of a discrete choice experiment (DCE) and a best-worst scaling (BWS) instrument to quantify the treatment outcome preferences of patients with hematologic malignancies to inform shared decision making. Objective We aim to develop an electronic health care tool (EHT) to guide clinical decision making that uses either a BWS or DCE instrument to capture patient preferences. The primary objective of this study is to use both qualitative and quantitative methods to evaluate the perceived usability, cognitive workload (CWL), and performance of electronic prototypes that include the DCE and BWS instrument. Methods This mixed methods study includes iterative co-design methods that will involve healthy volunteers, patient-caregiver pairs, and health care workers to evaluate the perceived usability, CWL, and performance of tasks within distinct prototypes. Think-aloud sessions and semistructured interviews will be conducted to collect qualitative data to develop an affinity diagram for thematic analysis. Validated assessments (Post-Study System Usability Questionnaire [PSSUQ] and the National Aeronautical and Space Administration’s Task Load Index [NASA-TLX]) will be used to evaluate the usability and CWL required to complete tasks within the prototypes. Performance assessments of the DCE and BWS will include the evaluation of tasks using the Single Easy Questionnaire (SEQ), time to complete using the prototype, and the number of errors. Additional qualitative assessments will be conducted to gather participants’ feedback on visualizations used in the Personalized Treatment Preferences Dashboard that provides a representation of user results after completing the choice tasks within the prototype. Results Ethical approval was obtained in June 2021 from the Institutional Review Board of the University of North Carolina at Chapel Hill. The DCE and BWS instruments were developed and incorporated into the PRIME (Preference Reporting to Improve Management and Experience) prototype in early 2021 and prototypes were completed by June 2021. Heuristic evaluations were conducted in phase 1 and completed by July 2021. Recruitment of healthy volunteers began in August 2021 and concluded in September 2021. In December 2021, our findings from phase 2 were accepted for publication. Phase 3 recruitment began in January 2022 and is expected to conclude in September 2022. The data analysis from phase 3 is expected to be completed by November 2022. Conclusions Our findings will help differentiate the usability, CWL, and performance of the DCE and BWS within the prototypes. These findings will contribute to the optimization of the prototypes, leading to the development of an EHT that helps facilitate shared decision making. This evaluation will inform the development of EHTs to be used clinically with patients and health care workers. International Registered Report Identifier (IRRID) DERR1-10.2196/39586
Collapse
Affiliation(s)
- Amy Cole
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel R Richardson
- University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karthik Adapa
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amro Khasawneh
- Industrial Engineering Department, School of Engineering, Mercer University, Macon, GA, United States
| | - Norah Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Lukasz Mazur
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
23
|
Brandt T, Frangiosa T, Biggar V, Taylor A, Valentine J, Keller B, Price M, DeMuro C, Abler V. Symptoms and Treatment Needs of People with Dementia-Related Psychosis: A Mixed-Methods Study of the Patient Experience. Clin Gerontol 2022; 45:681-695. [PMID: 34369313 DOI: 10.1080/07317115.2021.1957050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study describes the person-centered experience and impact of symptoms and the treatment needs of dementia-related psychosis (DRP) from a patient and care partner perspective. METHODS Qualitative interviews and a quantitative survey were used to collect patient experience data from persons with DRP or their care partners. RESULTS Sixteen participants (1 person with DRP, 15 care partners) completed the qualitative interview; 212 participants (26 persons with DRP, 186 care partners) completed the quantitative survey. The most commonly reported symptoms were visual hallucinations, auditory hallucinations, persecutory delusions, and distortion of senses. The most common impacts were difficulty differentiating what is real from what is not real, increased anxiety, and effects on personal relationships. Current treatments were less than moderately helpful, and the ability to distinguish what is real from what is not real and overall symptom improvement were described as the most important benefits of an ideal treatment. CONCLUSIONS Patient experience data provide insights into urgent therapeutic needs of patients by describing the nature, frequency, and severity of symptoms and the impacts they have on individuals' lives. CLINICAL IMPLICATIONS Patient experience data demonstrate an unmet need for treatments to reduce the symptoms and impacts of DRP.
Collapse
Affiliation(s)
- Teresa Brandt
- Acadia Pharmaceuticals Inc, San Diego, California, USA
| | | | | | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - James Valentine
- Hyman, Phelps & McNamara, P.C, Washington, DC, USA.,Carey School of Law, University of Maryland, Baltimore, Maryland, USA
| | - Bill Keller
- Acadia Pharmaceuticals Inc, San Diego, California, USA
| | - Mark Price
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Carla DeMuro
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Victor Abler
- Acadia Pharmaceuticals Inc, San Diego, California, USA
| |
Collapse
|
24
|
Carson RT. Patient Experience Data for Medical Product Development: Opportunity Beyond Obligation. THE PATIENT 2022; 15:147-149. [PMID: 35083736 DOI: 10.1007/s40271-021-00570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Robyn T Carson
- Patient-Centered Outcomes Research, HEOR, AbbVie, 5 Giralda Farms, Madison, NJ, 07960, USA.
| |
Collapse
|
25
|
Retzer A, Aiyegbusi OL, Rowe A, Newsome PN, Douglas-Pugh J, Khan S, Mittal S, Wilson R, O'Connor D, Campbell L, Mitchell SA, Calvert M. The value of patient-reported outcomes in early-phase clinical trials. Nat Med 2022; 28:18-20. [PMID: 35039659 DOI: 10.1038/s41591-021-01648-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK
| | - Anna Rowe
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jessica Douglas-Pugh
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sheeba Khan
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Roger Wilson
- NCRI Consumer Forum National Cancer Research Institute, London, UK
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK.
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- UK SPINE, University of Birmingham, Birmingham, UK.
| |
Collapse
|
26
|
Roberts JC, Recht M, Gonzales SE, Stanley J, Denne M, Caicedo J, Rockwood K. Incorporating the patient voice and patient engagement in GOAL-Hēm: Advancing patient-centric hemophilia care. Res Pract Thromb Haemost 2022; 6:e12655. [PMID: 35155975 PMCID: PMC8822263 DOI: 10.1002/rth2.12655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Goal Attainment Scaling for Hemophilia (GOAL-Hēm) is a novel, hemophilia-specific, validated patient engagement tool and patient-reported outcome instrument. OBJECTIVE We evaluated the degree to which the language of GOAL-Hēm was patient-centric and the content valuable and relevant for people with hemophilia (PWH) and/or their caregivers. PATIENTS/METHODS Patients and caregivers participated in one of three investigations: an online survey, one-on-one patient interviews, or a focus group. The survey and interviews assessed the clarity and relevance of the GOAL-Hēm menu items. Interviews were semistructured, audio recorded, and transcribed verbatim. Feedback from interviews was coded as "clear," "unclear," "remove," or "add." The focus group explored participants' experience of GOAL-Hēm and elicited recommendations for implementation. Quotations from focus group and interview transcripts were indexed and charted to emergent themes for analysis. RESULTS Participants comprised 19 adults with hemophilia and 19 caregivers of children with hemophilia (survey, n = 20; interview, n = 12; focus group, n = 6). After their feedback, 32% (15/48) of goals were retained unchanged. Further feedback resulted in the removal of 45% (286/635) of the goal descriptors, and 30% (193/635) of the retained descriptors were modified. Three new (total = 38) goals and 42 descriptors (total = 368) were added to the menu. Thematic analysis indicated that participants were enthusiastic about patient-centric language, empowered through the goal-setting process, and recognized GOAL-Hēm could measure clinically meaningful change. CONCLUSION By listening closely to patients and caregivers, we refined GOAL-Hēm to better capture the experiences of PWH, enhance content validity, and augment implementation strategies. Incorporating the patient voice is integral to developing patient-centered outcome measures.
Collapse
Affiliation(s)
| | - Michael Recht
- The Hemophilia Center at Oregon Health & Science UniversityPortlandOregonUSA
- American Thrombosis and Hemostasis NetworkRochesterNew YorkUSA
| | | | | | | | | | - Kenneth Rockwood
- Ardea OutcomesHalifaxNova ScotiaCanada
- Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| |
Collapse
|
27
|
Haag S, Junge L, Lotz F, McGauran N, Paulides M, Potthast R, Kaiser T. Results on patient-reported outcomes are underreported in summaries of product characteristics for new drugs. J Patient Rep Outcomes 2021; 5:127. [PMID: 34874524 PMCID: PMC8651888 DOI: 10.1186/s41687-021-00402-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Summaries of product characteristics (SmPCs) are regulatory documents published upon drug approval. They should report all relevant study data and advise how to use drugs safely and effectively. Patient-reported outcomes (PROs) are increasingly used in clinical trials to incorporate the patient perspective-SmPCs should thus adequately report PROs. In Germany, new drugs undergo mandatory early benefit assessment. Pharmaceutical companies submit dossiers containing all evidence; the subsequent dossier assessments focus on patient-relevant outcomes and comprehensively report PROs. OBJECTIVE The primary aim was to investigate to what extent PROs recorded as outcomes in clinical trials of new drugs are reported in SmPCs. METHODS We analysed dossier assessments with randomized controlled trials (RCTs) of new drugs entering the market between 01/2014 and 07/2018 and the corresponding SmPCs, and compared PRO reporting in both document types. For this purpose, we evaluated dossier assessment characteristics (e.g. drug name, indication, disease category) and study characteristics (e.g. evaluable PROs available?). PROs were divided into symptoms and health-related quality of life (HRQoL). SmPCs were screened to identify RCTs. We conducted 3 main evaluation steps: (1) Did the RCT included in the dossier assessment contain evaluable PROs? (2) If yes, was the RCT included in the SmPC? (3) If yes, were the PROs reported in the SmPC? Results are presented descriptively. RESULTS 88 dossier assessments including 143 RCTs on 72 drugs were considered: 109 (76.2%) RCTs included evaluable PROs, of which 89 were included in SmPCs. 38 RCTs (42.7%) investigated oncologics, 18 (20.2%) anti-infectives, and 33 (37.1%) other drugs. The RCTs considered symptoms more often than HRQoL (82 vs. 66 RCTs). In SmPCs, PROs were reported for 41 RCTs (46.1%), with a slightly higher reporting rate for RCTs considering HRQoL (43.9%) than for RCTs considering symptoms (41.5%). In oncologic indications, PROs were reported for 36.7% of RCTs considering HRQoL and 33.3% of RCTs considering symptoms. In infectious diseases, the rates were 21.4% (symptoms) and 0% (HRQoL), and for other diseases about 60% (symptoms) to 70% (HRQoL). CONCLUSION Even though a large amount of PRO data on new drugs is available from clinical trials included in SmPCs, the corresponding results are underreported.
Collapse
Affiliation(s)
- Susanne Haag
- Institute for Quality and Efficiency in Health Care, Cologne, Germany.
| | - Lisa Junge
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Fabian Lotz
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Natalie McGauran
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Marios Paulides
- Drug Commission of the German Medical Association, Berlin, Germany
| | - Regine Potthast
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Thomas Kaiser
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| |
Collapse
|
28
|
Busner J, Pandina G, Domingo S, Berger AK, Acosta MT, Fisseha N, Horrigan J, Ivkovic J, Jacobson W, Revicki D, Villalta-Gil V. Clinician- and Patient-reported Endpoints in CNS Orphan Drug Clinical Trials: ISCTM Position Paper on Best Practices for Endpoint Selection, Validation, Training, and Standardization. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:15-22. [PMID: 35096477 PMCID: PMC8794479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The International Society of CNS Clinical Trials Methodology (ISCTM) Working Group on Rare Disease/Orphan Drug Development is dedicated to improving and streamlining trials to best develop new treatments for rare diseases. The rarity of these disorders requires a drug development strategy that differs from those of nonrare conditions. Rare disease drug development programs are challenged with small sample sizes, heterogeneous clinical presentations, and few, if any, off-the-shelf endpoints. When disease-specific clinical endpoints exist, they might not be validated and are typically not well known or broadly used in clinical practice. This paper aims to provide an overview of the special issues surrounding endpoints in rare disease drug development, with guidance, practical applications, and discussion. DISCUSSION The paper covers regulatory considerations in endpoint selection; identification of relevant measurement domains; methods of quantifying clinical meaningfulness; incorporation of patient- and clinician-reported outcomes; considerations for global clinician- and patient-rated clinical assessments; cognition assessment challenges in rare diseases; translation considerations; training, standardization, and calibration of assessors; and endpoint quality assurance. Additionally, it provides guidance and resources for those involved in drug development for rare diseases. CONCLUSION In keeping with the mission of ISCTM and the rare disease/orphan drug development working group, this article is designed to encourage thoughtful consideration and provide insight and guidance to promote and further efforts in in central nervous system (CNS) rare disease drug development efforts.
Collapse
Affiliation(s)
- Joan Busner
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Gahan Pandina
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - SilviaZaragoza Domingo
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Anna-Karin Berger
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Maria T Acosta
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Nahome Fisseha
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Joseph Horrigan
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Jelena Ivkovic
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - William Jacobson
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Dennis Revicki
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Victoria Villalta-Gil
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| |
Collapse
|
29
|
Boye KS, Jordan JB, Malik RE, Currie BM, Matza LS. Patient Perceptions of and Preferences Between Characteristics of Injectable Diabetes Treatments. Diabetes Ther 2021; 12:2387-2403. [PMID: 34297341 PMCID: PMC8385031 DOI: 10.1007/s13300-021-01097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The administration of medications targeting type 2 diabetes mellitus (T2D) has evolved over time. As injection delivery systems continue to evolve, it is necessary to understand patients' perceptions of currently available treatments. The objective of this study was to examine the patient perspective of injectable treatment for T2D and identify characteristics of these treatments that are most important to patients. METHODS Data were collected via an online survey study with a sample of individuals in the UK and US who were treated for T2D with injectable medication. The survey was designed to elicit perceptions of the treatment process for injectable glucagon-like peptide 1 (GLP-1) receptor agonists and insulin. RESULTS The sample included 504 participants (251 UK, 253 US). Approximately half (50.4%) were treated with a GLP-1 receptor agonist and half (49.6%) were treated with insulin. Respondents were presented with a list of 17 characteristics of injectable medication and asked to indicate which were most important to them. Respondents most frequently selected confidence in administering the correct dose (n = 300, 59.5%); ease of selecting the correct dose (n = 268, 53.2%); overall ease of using the injection device (n = 239, 47.4%); frequency of injections (n = 223, 44.2%); and ease of carrying the device when necessary to inject away from home (n = 190, 37.7%). Characteristics least frequently cited as important included dose escalation (n = 79, 15.7%); handling the needle (n = 74, 14.7%); connectivity to an electronic device (n = 70, 13.9%); and the time required to prepare and inject each dose (n = 62, 12.3%). CONCLUSION Results of this survey suggest that patients prioritize some attributes of injectable treatments over others. These findings may have implications for clinical practice and development of injection devices.
Collapse
Affiliation(s)
| | | | | | - Brooke M. Currie
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | - Louis S. Matza
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| |
Collapse
|
30
|
Juandó-Prats C, James E, Bilder DA, McNair L, Kenneally N, Helfer J, Huang N, Vila MC, Sullivan J, Wirrell E, Rico S. DRAVET ENGAGE. Parent caregivers of children with Dravet syndrome: Perspectives, needs, and opportunities for clinical research. Epilepsy Behav 2021; 122:108198. [PMID: 34284219 DOI: 10.1016/j.yebeh.2021.108198] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022]
Abstract
Dravet syndrome (DS) is an intractable developmental and epileptic encephalopathy significantly impacting affected children and their families. A novel, one-time, adeno-associated virus (AAV)-mediated gene regulation therapy was designed to treat the underlying cause of DS, potentially improving the full spectrum of DS manifestations. To ensure the first-in-human clinical trial addresses meaningful outcomes for patients and families, we examined their perspectives, priorities, goals, and desired outcomes in the design phase through a mixed methods approach (quantitative and qualitative). We conducted a non-identifiable parent caregiver survey, shared through a patient advocacy organization (n = 36 parents; children age ≤6 years). Parents were also engaged via three group discussions (n = 10; children age 2-20 years) and optional follow-up in-depth individual interviews (n = 6). Qualitative data analysis followed an inductive interpretive process, and qualitative researchers conducted a thematic analysis with a narrative approach. Survey results revealed most children (94%) were diagnosed by age 1, with onset of seizures at mean age 6.2 months and other DS manifestations before 2 years. The most desired disease aspects to address with potential new disease-modifying therapies were severe seizures (ranked by 92% of caregivers) and communication issues (development, expressive, receptive; 72-83%). Qualitative results showed the need for trial outcomes that recognize the impact of DS on the whole family. Parents eventually hope for trials including children of all ages and were both excited about the potential positive impact of a one-time disease-modifying therapy and mindful of potential long-term implications. Participants reflected on the details and risks of a clinical trial design (e.g., sham procedures) and described the different factors that relate to their decision to participate in a trial. Their main aspirations were to stop neurodevelopmental stagnation, to reduce seizures, and to reduce the impact on their families' wellbeing. To our knowledge, this is the first study within a patient-oriented research framework that specifically explored parents' needs and perceptions regarding clinical trials of a potential disease-modifying therapy for children with a severe, developmental disease, such as DS.
Collapse
Affiliation(s)
- Clara Juandó-Prats
- Dalla Lana School of Public Health, University of Toronto, ON, Canada; Applied Health Research Center, St. Michael's Hospital, Unity Health Toronto, ON, Canada.
| | - Emma James
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
| | | | | | - Noah Kenneally
- Humane Services and Early Learning, MacEwan University, Edmonton, AB, Canada
| | | | - Norman Huang
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
| | | | - Joseph Sullivan
- University of California, San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Salvador Rico
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
| |
Collapse
|
31
|
Feldman D, Kruger P, Delbecque L, Duenas A, Bernard-Poenaru O, Wollenschneider S, Hicks N, Reed JA, Sargeant I, Pakarinen C, Hamoir AM. Co-creation of practical "how-to guides" for patient engagement in key phases of medicines development-from theory to implementation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:57. [PMID: 34425911 PMCID: PMC8383358 DOI: 10.1186/s40900-021-00294-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/25/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND The effective impact of patient engagement (PE) across the medicines development continuum is widely acknowledged across diverse health stakeholder groups, including health authorities; however, the practical applications of how to implement meaningful and consistent PE are not always addressed. Guidance for the practical implementation of PE requires granularity, and the need for such guidance has been identified as a priority. We describe the co-production and summarize the content of how-to guides that focus on PE in the early stages of medicines development. METHODS Multi-stakeholder working groups (WGs) were established by Patient Focused Medicines Development (PFMD) for how-to guide development. How-to guides were co-produced with patients for PE activities identified as priorities through public consultation and by WGs. Guides were developed by applying PE quality guidance and associated quality criteria in an iterative process. How-to guides underwent internal review and validation by experts (ie, those with relevant experience in the particular PE activity or focus area) in specific focus groups and external review and validation through appropriate events and public consultation. RESULTS Overall, 103 individual contributors from 38 organizations (representing eight stakeholder groups, including patients/patient organizations) and from 14 countries were organized into WGs and workstreams. Each WG comprised 15-30 contributors with PE experience relevant to the specific how-to guide. How-to guides were developed for PE in the early discovery and preclinical phases; PE in the development of a clinical outcomes assessment strategy; and PE in clinical trial protocol design. The how-to guides have a standardized format and structure to promote user familiarity. They provide detailed guidance and examples that are relevant to the individual PE activity and aim to facilitate the practical implementation of PE. CONCLUSIONS The how-to guides form a comprehensive series of actionable and stepwise resources that build from and integrate the PE quality criteria across the medicines continuum. They will be made freely available through PFMD's Patient Engagement Management Suite ( pemsuite.org ) and shared widely to a variety of audiences in different settings, ensuring access to diverse patient populations. Implementation of these guides should advance the field of PE in bringing new medicines to the market and ultimately will benefit patients. Medicines are developed to help patients improve their health and lives. Many organizations and individuals want to ensure that medicines are developed to meet real patient needs and to address what is most important to patients. Finding out what patients need and what patients want requires good patient engagement, but knowing how to do patient engagement is not always clear. This is because medicines development is complicated, and a lot of different steps, people, and organizations are involved. Patient Focused Medicines Development (PFMD) was established in 2015 to connect individuals and organizations that are committed to making medicines not just for patients but with patients. To do this, PFMD brought together patients and other groups of people with relevant experience and good ideas on how to achieve patient engagement in the real-world setting. Together, PFMD has developed "how-to guides" for patient engagement that cover the main activities along the medicines development process. The guides are free to use and provide practical advice and examples that anyone can use in their patient engagement activities. The how-to guides will also help patients to understand medicines development and how best they can participate in this process to address their needs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nick Hicks
- Commutateur Advocacy Communications, Paris, France
| | - Janine Ann Reed
- National Kidney Foundation, Alport Syndrome Foundation, New York, NY, USA
| | | | | | | |
Collapse
|
32
|
Coleman RL, Beck JT, Baranda JC, Jacobs I, Smoyer KE, Lee LJ, Askerova Z, McGinnis J, Ganti AK. The Use of Patient-Reported Outcome Measures in Phase I Oncology Clinical Trials. Oncology 2021; 99:444-453. [PMID: 33823518 DOI: 10.1159/000514874] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate patient-reported outcome (PRO) usage in phase I oncology clinical trials, including types of PRO measures and changes over time. METHODS We analyzed ClinicalTrials.gov records of phase I oncology clinical trials completed by December 2019. RESULTS Of all eligible trials, 2.3% (129/5,515) reported ≥1 PRO, totaling 181 instances of PRO usage. PRO usage increased over time, from 0.6% (trials initiated before 2000) to 3.4% (trials starting between 2015 and 2019). The most common PRO measures were unspecified (29%), tumor-specific (24%), and generic cancer (19%). CONCLUSION Although uncommon in phase I oncology clinical trials, PRO usage is increasing over time. PRO measures were often unspecified on ClinicalTrials.gov, suggesting that more precise reporting and standardization are needed.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Apar Kishor Ganti
- VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
33
|
DuBrock HM, Nathan SD, Reeve BB, Kolaitis NA, Mathai SC, Classi PM, Nelsen AC, Olayinka-Amao B, Norcross LN, Martin SA. Pulmonary hypertension due to interstitial lung disease or chronic obstructive pulmonary disease: a patient experience study of symptoms and their impact on quality of life. Pulm Circ 2021; 11:20458940211005641. [PMID: 33868642 PMCID: PMC8020242 DOI: 10.1177/20458940211005641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension resulting from chronic lung disease such as chronic obstructive pulmonary disease and interstitial lung disease is categorized by the World Health Organization as Group 3 pulmonary hypertension. To identify the symptoms and impacts of World Health Organization Group 3 pulmonary hypertension and to capture data related to the patient experience of this disease, qualitative research interviews were undertaken with 3 clinical experts and 14 individuals with pulmonary hypertension secondary to chronic obstructive pulmonary disease or interstitial lung disease. Shortness of breath, fatigue, cough, and swelling were the most frequently reported symptoms of pulmonary hypertension due to chronic obstructive pulmonary disease or interstitial lung disease, and shortness of breath was further identified as the single most bothersome symptom for most patients (71.4%). Interview participants also described experiencing a number of impacts related to pulmonary hypertension and pulmonary hypertension symptoms, including limitations in the ability to perform activities of daily living and impacts on physical functioning, family life, and social life as well as emotional impacts, which included frustration, depression, anxiety, isolation, and sadness. Results of these qualitative interviews offer an understanding of the patient experience of pulmonary hypertension due to chronic obstructive pulmonary disease or interstitial lung disease, including insight into the symptoms and impacts that are most important to patients in this population. As such, these results may help guide priorities in clinical treatment and assist researchers in their selection of patient-reported outcome measures for clinical trials in patients with pulmonary hypertension due to chronic obstructive pulmonary disease or interstitial lung disease.
Collapse
Affiliation(s)
- Hilary M. DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, USA
| | | | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School
of Medicine, Durham, NC, USA
| | - Nicholas A. Kolaitis
- Division of Pulmonary, Critical Care, Allergy, and Sleep
Medicine, San Francisco Medical Center, University of California, San Francisco,
CA, USA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - Peter M. Classi
- Global Medical Affairs, United Therapeutics, Durham, NC,
USA
| | | | | | | | - Susan A. Martin
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Ann
Arbor, MI, USA
| |
Collapse
|
34
|
Whittal A, Meregaglia M, Nicod E. The Use of Patient-Reported Outcome Measures in Rare Diseases and Implications for Health Technology Assessment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:485-503. [PMID: 33462774 PMCID: PMC8357707 DOI: 10.1007/s40271-020-00493-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 12/17/2022]
Abstract
Background Patient-reported outcome measures (PROMs) are used in health technology assessment (HTA) to measure patient experiences with disease and treatment, allowing a deeper understanding of treatment impact beyond clinical endpoints. Developing and administering PROMs for rare diseases poses unique challenges because of small patient populations, disease heterogeneity, lack of natural history knowledge, and short-term studies. Objective This research aims to identify key factors to consider when using different types of PROMs in HTA for rare disease treatments (RDTs). Methods A scoping review of scientific and grey literature was conducted, with no date or publication type restrictions. Information on the advantages of and the challenges and potential solutions when using different types of PROMs for RDTs, including psychometric properties, was extracted and synthesized. Results Of 79 records from PubMed, 32 were included, plus 12 records from the grey literature. PROMs for rare diseases face potential data collection and psychometric challenges resulting from small patient populations and disease heterogeneity. Generic PROMs are comparable across diseases but not sensitive to disease specificities. Disease-specific instruments are sensitive but do not exist for many rare diseases and rarely provide the utility values required by some HTA bodies. Creating new PROMs is time and resource intensive. Potential solutions include pooling data (multi-site/international data collection), using computer-assisted technology, or using generic and disease-specific PROMs in a complementary way. Conclusions PROMs are relevant in HTA for RDTs but pose a number of difficulties. A deeper understanding of the potential advantages of and the challenges and potential solutions for each can help manage these difficulties. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-020-00493-w.
Collapse
Affiliation(s)
- Amanda Whittal
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy.
| | - Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy
| | - Elena Nicod
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy
| |
Collapse
|
35
|
Dillon C, Knapp J, Stinson M. An Evolved Approach to Advisory Boards in Rare Disease Drug Development: 5-Step Model to Finding and Engaging Patient Advisors. J Patient Exp 2021; 7:978-981. [PMID: 33457532 PMCID: PMC7786749 DOI: 10.1177/2374373520948441] [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] [Indexed: 11/25/2022] Open
Abstract
Nearly all new product development teams at pharmaceutical companies will routinely conduct patient advisory boards. These board meetings will help collect and document the experience of patients and caregivers for medical product development and regulatory decision-making. Recently, in June 2020, The US Food and Drug Administration (FDA) published a final guidance on methodological patient-focused drug development (PFDD) to address, in a stepwise manner, how stakeholders (patients, researchers, medical product developers, and others) can successfully use these patient forums. In the process of developing this guidance, the FDA acknowledged that leading its own PFDD meetings, especially when limited to organized disease advocacy groups, cannot address the gaps in information on the patient perspective. So, it has expressed support for advancing the science and utilization of patient input other means. Because traditional methods of conducting patient advisory boards often do not achieve the full potential of patient centricity, the authors of this article share an approach to consider when selecting patient advisors, in order to gain the most actionable input to a product development team.
Collapse
Affiliation(s)
| | - Joyce Knapp
- Knapp Healthcare Communications, New York, NY, USA
| | - Mark Stinson
- Bioscience Bridge LLC and 83bar LLC, Boise, ID, USA
| |
Collapse
|
36
|
Schultz-Knudsen K, Sabaliauskaite U, Hellsten J, Lassen AB, Morant AV. New Drug and Biologics Approvals in 2019: A Systematic Analysis of Patient Experience Data in FDA Drug Approval Packages and Product Labels. Ther Innov Regul Sci 2020; 55:503-513. [PMID: 33230660 PMCID: PMC8021513 DOI: 10.1007/s43441-020-00244-x] [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: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
Background The FDA Patient-Focused Drug Development Initiative was launched to ensure the incorporation of the patient voice into drug development and evaluation. Since 2017, the FDA must publish a statement outlining patient experience data (PED) considered in the approval of new drugs. This study investigated the presence and role of PED in drug approval and translation into product label claims. Methods PED reported in approval packages of the 48 drugs approved by FDA’s Center for Drug Evaluation and Research in 2019 was identified and categorized. PED in the form of clinical outcome assessments (COAs) was characterized by endpoint positioning and outcome. The product labels were analyzed for PED-related claims. Results PED was reported as relevant for 39 of 48 (81.3%) drugs approved in 2019. COAs were the predominant PED type; other PED was identified for only 9 (18.8%) drugs, and none included qualitative or patient preference studies. COAs were the only type of PED for which associated claims were identified in the product labels. 27 out of 48 (56.3%) labels contained one or more efficacy claims based on COAs; of these, patient-reported outcomes were the most prevalent with claims identified in 19 labels (39.6%). Conclusion There are ample opportunities for incorporating PED beyond COAs to inform drug development and facilitate availability of medicines tailored to patient needs. A higher level of transparency on the role of PED in regulatory decision-making and a clear path to PED-based label claims could incentivize sponsors and enable patient empowerment in treatment decisions. Electronic supplementary material The online version of this article (10.1007/s43441-020-00244-x) contains supplementary material, which is available to authorized users.
Collapse
|
37
|
Tanaka M, Idei M, Sakaguchi H, Kato R, Sato D, Sawanobori K, Kawarasaki S, Hata T, Yoshizaki A, Nakamura M, Ikuma M. Evolving Landscape of New Drug Approval in Japan and Lags from International Birth Dates: Retrospective Regulatory Analysis. Clin Pharmacol Ther 2020; 109:1265-1273. [PMID: 33048367 PMCID: PMC8246743 DOI: 10.1002/cpt.2080] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
Abstract
The Pharmaceuticals and Medical Devices Agency (PMDA) has approved hundreds of new drugs in recent years. We retrospectively analyzed the new drugs approved in Japan from 2008 to 2019, and identify the first-in-world approvals and clarify the current drug lag. The new drug and the drug lag were defined as a drug with a new active substance and a difference between the approval date in Japan and the international birth date, respectively. Among 400 new drugs approved in Japan during the last 12 years, 80 (20.0%) were first approved in Japan, and 320 were outside Japan (the United States: 202, 50.5%; Europe: 82, 20.5%; other regions: 36, 9.0%). Of these, 45 new drugs have not yet been approved outside Japan, and the remaining 355 have been globally approved in Japan and overseas. The number of new drug approvals were the largest in oncology followed by metabolic/endocrine and infectious diseases. The median drug lags (year) among all 400 new drugs and 355 new drugs with global approvals were 4.3 and 4.7 in the first tertile (2008-2011), 1.5 and 2.6 in the second tertile (2012-2015), and reduced to 1.3 and 2.2 in the third tertile (2016-2019), respectively. Substantial drug lag remains in neurology, psychiatry, and therapeutic areas where the number of new drug approvals was relatively small. Collectively, one-fifth of the new drugs approved in Japan are first-in-world approvals. Drug lag has been greatly decreased, although it still exists.
Collapse
Affiliation(s)
- Mototsugu Tanaka
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Mayumi Idei
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Hiroshi Sakaguchi
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Ryosuke Kato
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Daisuke Sato
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Kenji Sawanobori
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Shuichi Kawarasaki
- Office of New Drug 2, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Toshiyuki Hata
- Office of New Drug 3, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Asako Yoshizaki
- Office of New Drug 4, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Miki Nakamura
- Office of New Drug 5, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Mutsuhiro Ikuma
- Office of New Drug 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| |
Collapse
|
38
|
Williams CP, Gallagher KD, Deehr K, Aswani MS, Azuero A, Daniel CL, Ford EW, Ingram SA, Balch AJ, Rocque GB. Quantifying treatment preferences and their association with financial toxicity in women with breast cancer. Cancer 2020; 127:449-457. [PMID: 33108023 DOI: 10.1002/cncr.33287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the current study was to understand treatment preferences and their association with financial toxicity in Patient Advocate Foundation clients with breast cancer. METHODS This choice-based conjoint analysis used data from a nationwide sample of women with breast cancer who received assistance from the Patient Advocate Foundation. Choice sets created from 13 attributes of 3 levels each elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference archetypes. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity. Adjusted generalized linear models estimated COST score differences by preference archetype. RESULTS Of 220 respondents (for a response rate of 10%), the median age was 58 years (interquartile range, 49-66 years); 28% of respondents were Black, indigenous, or people of color; and approximately 60% had household incomes <$40,000. The majority of respondents were diagnosed with early-stage cancer (91%), 38% had recurrent disease, and 61% were receiving treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living. Two distinct treatment preference archetypes emerged. The "cost-prioritizing group" (75% of respondents) was most concerned about affordability, impact on activities of daily living, and burdening care partners. The "functional independence-prioritizing group" (25% of respondents) was most concerned about their ability to work, physical side effects, and interference with life events. COST scores were found to be similar between the archetypes in adjusted models (cost-prioritizing group COST score, 12 [95% confidence interval, 9-14]; and functional independence-prioritizing COST score, 11 [95% confidence interval, 9-13]). CONCLUSIONS Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision making could optimize patients' treatment experiences.
Collapse
Affiliation(s)
- Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Katie Deehr
- Patient Advocate Foundation, Hampton, Virginia
| | - Monica S Aswani
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Casey L Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, Alabama
| | - Eric W Ford
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
39
|
Lambert J, Marrel A, D'Angelo SP, Burgess MA, Chmielowski B, Fazio N, Gambichler T, Grob JJ, Lebbé C, Robert C, Russell J, Güzel G, Bharmal M. Patient Experiences with Avelumab in Treatment-Naïve Metastatic Merkel Cell Carcinoma: Longitudinal Qualitative Interview Findings from JAVELIN Merkel 200, a Registrational Clinical Trial. THE PATIENT 2020; 13:457-467. [PMID: 32472503 PMCID: PMC7340640 DOI: 10.1007/s40271-020-00428-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Avelumab is approved for the treatment of metastatic Merkel cell carcinoma, a rare aggressive skin cancer with a poor prognosis. The aim of this qualitative study embedded in a clinical trial was to explore patient experiences while receiving avelumab. METHODS All treatment-naïve patients with metastatic Merkel cell carcinoma entering part B of the phase II, open-label, international, JAVELIN Merkel 200 trial (NCT02155647) were invited to participate in optional semi-structured phone interviews before avelumab administration (baseline) and at weeks 13 and 25. Interviews were conducted by trained professionals, audio-recorded, transcribed and analysed. Key concepts identified at baseline were assessed during follow-up interviews. RESULTS Twenty-nine patients completed the baseline interview; 19 had at least one follow-up interview. Baseline interviews described the patients' challenging journeys before being correctly diagnosed with Merkel cell carcinoma, the negative psychological burden of living with a symptomless disease and the hope for avelumab to be a successful therapy. During the trial, most patients reported an increased or continued sense of hope and willingness to fight metastatic Merkel cell carcinoma. Patients who self-reported disease improvement (n = 12) also reported stability or improvement in physical well-being and ability to do daily activities, having more energy, worrying less and being optimistic. Six patients who reported their condition as stable (n = 4) or worsened (n = 3) reported a worsening of physical well-being. Nine patients reported fatigue/tiredness on the day of and after receiving avelumab. Baseline and longitudinal experiences were similar across countries. CONCLUSIONS This study suggests that patients experience perceptible benefits in physical and psychological well-being following treatment success with first-line avelumab in metastatic Merkel cell carcinoma.
Collapse
MESH Headings
- Activities of Daily Living
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Merkel Cell/drug therapy
- Carcinoma, Merkel Cell/pathology
- Carcinoma, Merkel Cell/psychology
- Female
- Health Status
- Humans
- Interviews as Topic
- Longitudinal Studies
- Male
- Middle Aged
- Neoplasm Grading
- Quality of Life
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/psychology
Collapse
Affiliation(s)
| | | | - Sandra P D'Angelo
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr University, Bochum, Germany
| | - Jean-Jacques Grob
- Department of Dermatology, Aix-Marseille University, Marseille, France
| | - Céleste Lebbé
- Université de Paris, INSERM U976, and Dermatology and CIC, AP-HP, Saint Louis Hospital, Paris, France
| | - Caroline Robert
- Department of Dermatology, Institut Gustave Roussy, Villejuif, France
| | | | | | | |
Collapse
|
40
|
Joynt Maddox KE, Bleser WK, Das SR, Desai NR, Ng-Osorio J, O'Brien E, Psotka MA, Wadhera RK, Weintraub WS, Konig M. Value in Healthcare Initiative: Summary and Key Recommendations. Circ Cardiovasc Qual Outcomes 2020; 13:e006612. [PMID: 32683984 DOI: 10.1161/circoutcomes.120.006612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In spring 2018, the American Heart Association convened the Value in Healthcare Summit to begin an important conversation about the challenges patients with cardiovascular disease face in accessing and deriving quality and value from the healthcare system. Following the summit and recognizing the collective momentum it created, the American Heart Association, in collaboration with the Robert J. Margolis Center for Health Policy at Duke University, launched the Value in Healthcare Initiative-Transforming Cardiovascular Care. Four areas of focus were identified, and learning collaboratives were established and proceeded to conduct concrete, actionable problem solving in 4 high-impact areas in cardiovascular care: Value-Based Models, Partnering with Regulators, Predict and Prevent, and Prior Authorization. The deliverables from these groups are being disseminated in 4 stand-alone articles, and their publication will initiate further work to test and evaluate each of these promising areas of reform. This article provides an overview of the initiative's findings and highlights key cross-cutting themes for consideration as the initiative moves forward.
Collapse
Affiliation(s)
- Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine and Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.E.J.-M.)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, NC (W.K.B.)
| | | | - Nihar R Desai
- Yale University School of Medicine, New Haven, CT (N.R.D.)
| | | | - Emily O'Brien
- Duke University School of Medicine, Durham, NC (E.O.)
| | | | - Rishi K Wadhera
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W.)
| | | | | |
Collapse
|
41
|
Warner JJ, Crook HL, Whelan KM, Bleser WK, Roiland RA, Hamilton Lopez M, Saunders RS, Wang TY, Hernandez AF, McClellan MB, Califf RM, Brown N. Improving Cardiovascular Drug and Device Development and Evidence Through Patient-Centered Research and Clinical Trials. Circ Cardiovasc Qual Outcomes 2020; 13:e006606. [DOI: 10.1161/circoutcomes.120.006606] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The pipeline of new cardiovascular drugs is relatively limited compared with many other clinical areas. Challenges causing lagging drug innovation include the duration and expense of cardiovascular clinical trials needed for regulatory evaluation and approvals, which generally must demonstrate noninferiority to existing standards of care and measure longer-term outcomes. By comparison, there has been substantial progress in cardiovascular device innovation. There has also been progress in cardiovascular trial participation equity in recent years, especially among women, due in part to important efforts by Food and Drug Administration, National Institutes of Health, American Heart Association, and others. Yet women and especially racial and ethnic minority populations remain underrepresented in cardiovascular trials, indicating much work ahead to continue recent success. Given these challenges and opportunities, the multistakeholder Partnering with Regulators Learning Collaborative of the Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University, identified how to improve the evidence generation process for cardiovascular drugs and devices. Drawing on a series of meetings, literature reviews, and analyses of regulatory options, the Collaborative makes recommendations across four identified areas for improvement. First, we offer strategies to enhance patient engagement in trial design, convenient participation, and meaningful end points and outcomes to improve patient recruitment and retention (major expenses in clinical trials). Second, new digital technologies expand the potential for real-world evidence to streamline data collection and reduce cost and time of trials. However, technical challenges must be overcome to routinely leverage real-world data, including standardizing data, managing data quality, understanding data comparability, and ensuring real-world evidence does not worsen inequities. Third, as trials are driven by evidence needs of regulators and payers, we recommend ways to improve their collaboration in trial design to streamline and standardize efficient and innovative trials, reducing costs and delays. Finally, we discuss creative ways to expand the minuscule proportion of sites involved in cardiovascular evidence generation and medical product development. These actions, paired with continued policy research into better ways to pay for and equitably develop therapies, will help reduce the cost and complexity of drug and device research, development, and trials.
Collapse
Affiliation(s)
- John J. Warner
- University of Texas Southwestern Medical Center, Dallas (J.J.W.)
| | - Hannah L. Crook
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Karley M. Whelan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - William K. Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Rachel A. Roiland
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Robert S. Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Tracy Y. Wang
- Duke University School of Medicine, Duke University, Durham, NC (T.Y.W., A.F.H.)
| | - Adrian F. Hernandez
- Duke University School of Medicine, Duke University, Durham, NC (T.Y.W., A.F.H.)
| | - Mark B. McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (H.L.C., K.M.W., W.K.B., R.A.R., M.H.L., R.S.S., M.B.M.)
| | - Robert M. Califf
- Verily Life Sciences, South San Francisco, CA (R.M.C.)
- Google Life Sciences, Palo Alto, CA (R.M.C.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
| | | |
Collapse
|
42
|
Abstract
This article presents the author's opinion on the past and present state of the Patient Engagement movement and discusses ways in which the movement will need to change and evolve if it is to become viable and standard practice in drug development. For most of the past decade, drug development sponsors-both government-funded and industry-funded research-have been aspirational in their support of Patient Engagement initiatives. New frameworks and guidelines have been proposed and developed, and a wide variety of initiatives have been planned and piloted. Many factors have facilitated a tentative and experimental posture-these include internal resistance to modifying legacy practices and processes; insufficient funding and staff to implement and manage initiatives; lack of clarity from regulatory and health authorities; and uncertainty around expected impact and return on investment. Recently, research sponsors have begun restructuring their Patient Engagement capabilities and they have been seeking more concrete return on engagement measures. These developments signal that the Patient Engagement movement has entered a new phase, becoming more rigorous as it seeks to balance ethical and moral obligations with scientific and business imperatives.
Collapse
Affiliation(s)
- Kenneth Getz
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA.
| |
Collapse
|
43
|
Pitts PJ. Towards Meaningful Engagement for the Patient Voice. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 12:361-363. [PMID: 31165399 DOI: 10.1007/s40271-019-00366-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peter J Pitts
- Center for Medicine in the Public Interest, University of Paris Descartes Medical School, New York, USA.
| |
Collapse
|
44
|
Tsang VWL, West L, Woods C, Koh CJ, McCune S, Mullin T, Smith SR, Gaillard S, Claverol J, Nafria B, Preston J, Dicks P, Thompson C. Role of Patients and Parents in Pediatric Drug Development. Ther Innov Regul Sci 2019; 53:601-608. [PMID: 30663334 PMCID: PMC6744949 DOI: 10.1177/2168479018820875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022]
Abstract
Patient engagement in health care has been an emerging priority in the global effort and move toward the consideration of patients as experts of their own conditions. However, the input of pediatric patients and their families have not been consistently requested nor regarded as valuable when deriving protocols for, as well as assessing the outcomes of, pediatric clinical trials. Extending this mutual collaboration further upstream is important, especially in the area of pediatric drug development where the lack of formalized trials for children and adolescents result in the increased use of off-label prescribing and risk of adverse effects. While recent changes to European and North American legislation contributed to the inclusion of children and youth in pediatric drug development, the lack of systematic guidelines and methodologies in literature serve as barriers for practical application. When combined with the work of external pediatric advocacy and patient advisory groups, the hope is that pediatric patient voices can be brought forward for the future. This article brings together international experts to review current best practices, progress from regulatory agencies, as well as global advocacy efforts to involve patients and families in the pursuit of drug development processes that value the voice of children and youth.
Collapse
Affiliation(s)
- Vivian W. L. Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leanne West
- Children’s Healthcare of Atlanta Pediatric Technology Center at the Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Chester J. Koh
- Division of Urology, Department of Surgery, Texas Children’s Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Susan McCune
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD, USA
| | - Theresa Mullin
- Associate Director for Strategic Initiatives, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD USA
| | - Sharon R. Smith
- Department of Pediatrics, University of Connecticut, CT Children’s Medical Center, Hartford, CT, USA
| | - Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France. Université de Lyon, Service de Pharmacologie Clinique, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, 69622, Villeurbanne, France. RIPPS (Réseau d’investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment “Les Tilleuls” 59 Boulevard Pinel 69677 Bron France
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, Clinical Research Unit, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Begonya Nafria
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu Pg. Sant Joan de Déu, Barcelona, Spain
| | - Jennifer Preston
- National Institute for Health Research, Alder Hey Children’s Hospital, University of Liverpool, UK
| | - Pamela Dicks
- National Health Service National Research Services Children’s Research Network, NHS Grampian, Scotland
| | - Charles Thompson
- Pfizer Inc, New York, NY, USA
- International Children’s Advisory Network, Hartford, CT, USA
| |
Collapse
|
45
|
Hansen MB, Nørgaard LS, Hallgreen CE. How and Why to Involve Patients in Drug Development: Perspectives From the Pharmaceutical Industry, Regulatory Authorities, and Patient Organizations. Ther Innov Regul Sci 2019:2168479019864294. [PMID: 31390896 DOI: 10.1177/2168479019864294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite increasing interest and focus on patient-centric approaches to drug development, there might still be divergent views between key stakeholders in how to perceive patient involvement and how possibly divergent views influence the role of patients in the drug development process. The objective of this study is to explore how the perception of patient organizations, pharmaceutical companies, and regulatory agencies influence the role of patients in drug development. METHOD A qualitative interview study based on 12 semi-structured interviews with representatives from the 3 stakeholders. Interviews were transcribed, and data were analyzed using a social constructivist approach in the form of systematic text condensation. RESULTS Three main perceptions of patient involvement were identified: "a way to improve quality of life," "a way to avoid business failure," and "a way to foster a faster drug approval process." Transparency, trust, and clarification of expectations and roles were factors perceived as prerequisites for a valuable collaboration. Furthermore, a required cultural mindset change in the pharmaceutical industry, the lack of a common framework, patient organizations having limited resources available, and concerns about what to do with patient responsibility were perceived as the most important barriers for patient involvement. CONCLUSION Based on the findings, the pharmaceutical industry, patient organizations, and regulatory authorities were labeled as "pioneer/dominant," "unaware/quiet," and "hesitant," respectively. The 3 behavioural descriptors reflect a limited negotiation of the role patients have in drug development. Thus, the pharmaceutical industry appears to be the largest influencer with regard to patients' role in drug development.
Collapse
Affiliation(s)
- Marianne Botoft Hansen
- 1 Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Stig Nørgaard
- 2 Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christine Erikstrup Hallgreen
- 1 Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
46
|
Contesse MG, Valentine JE, Wall TE, Leffler MG. The Case for the Use of Patient and Caregiver Perception of Change Assessments in Rare Disease Clinical Trials: A Methodologic Overview. Adv Ther 2019; 36:997-1010. [PMID: 30879250 PMCID: PMC6824378 DOI: 10.1007/s12325-019-00920-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The traditional model of evaluating treatments based primarily on primary outcome measures has stumbled in its application to rare disease. Rare disease clinical trials face the methodological challenges of small, heterogeneous patient populations and relatively few validated, disease-specific outcome measures. Incorporating qualitative research into rare disease clinical trials may help sponsors, regulators, payers, and prescribers to better understand the real-world and patient-specific impact of a potential therapy. This paper provides a methodologic overview of the use of Patient and Caregiver Perception of Change (PPC and CPC) Assessments utilizing patient and caregiver video interviews to complement the data captured by traditional endpoints in rare disease clinical trials. METHODS Incorporating qualitative patient and caregiver video interviews into clinical trials allows for the rigorous capture of patient experiences and caregiver observations. Interview guides informed by input from key stakeholders provide the opportunity to solicit structured feedback on experiences before, during, and after the clinical trial. Patients and caregivers can complete their video interviews in a study mobile application, and interview transcripts are analyzed by independent coders. Themes are summarized by the treatment group and individual patient, which adds context to the clinical outcome measures of how patients feel and function, as well as elucidates the degree of change that is meaningful to patients and caregivers. The qualitative results can be compared to the data captured in clinical trials to assess data concordance. CONCLUSION Capturing patient experience data with sufficient rigor allows it to contribute to the body of evidence utilized in regulatory, payer, and prescriber decision-making. Adding PPC and CPC Assessments to rare disease clinical trials offers an innovative and powerful way to tap into the unique insights of patients and their families to develop a fuller picture of the patient experience in the clinical trial. FUNDING Stealth BioTherapeutics Inc.
Collapse
|