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Barrio C, Fuentes D, Tibiriçá L, Hernandez M, Helu-Brown P, Golshan S, Palmer BW. Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia. Schizophr Bull 2024; 50:673-683. [PMID: 37962384 PMCID: PMC11059799 DOI: 10.1093/schbul/sbad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White). STUDY DESIGN Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures. STUDY RESULTS One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066-0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008). CONCLUSIONS Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.
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Affiliation(s)
- Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Dahlia Fuentes
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Lize Tibiriçá
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas, Austin, Austin, TX, USA
| | - Paula Helu-Brown
- Department of Psychology, Mount Saint Mary’s University, Los Angeles, CA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
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Hershfeld B, Klein B, White PB, Mont MA, Bitterman AD. Informed Consent in Orthopaedic Surgery: A Primer. J Bone Joint Surg Am 2024; 106:472-476. [PMID: 38190442 DOI: 10.2106/jbjs.23.00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Benjamin Hershfeld
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, New York
| | | | | | - Michael A Mont
- Northwell Orthopedics, New Hyde Park, New York
- Department of Orthopaedic Surgery, Sinai Hospital, Baltimore, Maryland
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Mikacenic C, Fussner LA, Bell J, Burnham EL, Chlan LL, Cook SK, Dickson RP, Almonor F, Luo F, Madan K, Morales-Nebreda L, Mould KJ, Simpson AJ, Singer BD, Stapleton RD, Wendt CH, Files DC. Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:621-631. [PMID: 37125997 PMCID: PMC10174130 DOI: 10.1513/annalsats.202302-106st] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Bronchoscopy for research purposes is a valuable tool to understand lung-specific biology in human participants. Despite published reports and active research protocols using this procedure in critically ill patients, no recent document encapsulates the important safety considerations and downstream applications of this procedure in this setting. The objectives were to identify safe practices for patient selection and protection of hospital staff, provide recommendations for sample procurement to standardize studies, and give guidance on sample preparation for novel research technologies. Seventeen international experts in the management of critically ill patients, bronchoscopy in clinical and research settings, and experience in patient-oriented clinical or translational research convened for a workshop. Review of relevant literature, expert presentations, and discussion generated the findings presented herein. The committee concludes that research bronchoscopy with bronchoalveolar lavage in critically ill patients on mechanical ventilation is valuable and safe in appropriately selected patients. This report includes recommendations on standardization of this procedure and prioritizes the reporting of sample management to produce more reproducible results between laboratories. This document serves as a resource to the community of researchers who endeavor to include bronchoscopy as part of their research protocols and highlights key considerations for the inclusion and safety of research participants.
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Forsman T, Silberstein S, Keller EJ. Consent in Interventional Radiology-How Can We Make It Better? Can Assoc Radiol J 2023; 74:202-210. [PMID: 35611696 DOI: 10.1177/08465371221101625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Informed consent is an important part of the clinician-patient relationship. However, studies suggest consent practices tend to be limited in consistency and completeness. This may be particularly challenging for interventional radiology given more limited public awareness and the often fast-paced, dynamic nature of our practices. This article reviews these challenges as well as ideal consent practices and potential approaches to improve consent in interventional radiology.
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Affiliation(s)
- Tia Forsman
- 12321The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Eric J Keller
- Division of Interventional Radiology, 6429Stanford University, Stanford, CA, USA
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Cooksey KE, Mozersky J, DuBois J, Kuroki L, Marx CM, Politi MC. Challenges and Possible Solutions to Adapting to Virtual Recruitment: Lessons Learned from a Survey Study during the Covid-19 Pandemic. Ethics Hum Res 2022; 44:23-31. [PMID: 36316973 PMCID: PMC9631333 DOI: 10.1002/eahr.500148] [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: 11/05/2022]
Abstract
The Covid-19 pandemic required rapid changes to research protocols, including immediate transitions to recruiting research participants and conducting the informed consent process virtually. This case study details the challenges our research team faced adapting an in-person, behavioral-intervention and survey study to virtual recruitment. We reflect on the impact of these rapid changes on recruitment and retention, discuss protocol changes we made to address these challenges and the needs of potential and enrolled participants, and propose recommendations for future work. Using computer technology to display professional return phone numbers, being flexible by contacting potential participants through various means, minimizing email communication due to added regulatory requirements, and partnering with the institutional review board to shorten and improve the consent document and process were critical to study success. This case study can offer insight to other researchers as they navigate similar processes. Virtual recruitment is likely to continue; it is important to ensure that it facilitates, rather than hinders, equitable and just recruitment practices.
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Affiliation(s)
- Krista E Cooksey
- Research coordinator in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
| | - Jessica Mozersky
- Assistant professor in the Bioethics Research Center in the Department of Medicine at Washington University School of Medicine
| | - James DuBois
- Steven J. Bander Professor of Medical Ethics and Professionalism in the Department of Medicine and the executive director of the Bioethics Research Center at Washington University School of Medicine
| | - Lindsay Kuroki
- Associate professor in the Division of Gynecologic Oncology in the Department of Obstetrics & Gynecology at Washington University School of Medicine
| | - Christine M Marx
- Research coordinator in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
| | - Mary C Politi
- Professor in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
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6
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Fisher H, Zabar S, Chodosh J, Langford A, Trinh-Shevrin C, Sherman S, Altshuler L. A novel simulation-based approach to training for recruitment of older adults to clinical trials. BMC Med Res Methodol 2022; 22:180. [PMID: 35764920 PMCID: PMC9238219 DOI: 10.1186/s12874-022-01643-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The need to engage adults, age 65 and older, in clinical trials of conditions typical in older populations, (e.g. hypertension, diabetes mellitus, Alzheimer's disease and related dementia) is exponentially increasing. Older adults have been markedly underrepresented in clinical trials, often exacerbated by exclusionary study criteria as well as functional dependencies that preclude participation. Such dependencies may further exacerbate communication challenges. Consequently, the evidence of what works in subject recruitment is less generalizable to older populations, even more so for those from racial and ethnic minority and low-income communities. METHODS To support capacity of research staff, we developed a virtual, three station simulation (Group Objective Structured Clinical Experience-GOSCE) to teach research staff communication skills. This 2-h course included a discussion of challenges in recruiting older adults; skills practice with Standardized Participants (SPs) and faculty observer who provided immediate feedback; and debrief to highlight best practices. Each learner had opportunities for active learning and observational learning. Learners completed a retrospective pre-post survey about the experience. SP completed an 11-item communication checklist evaluating the learner on a series of established behaviorally anchored communication skills (29). RESULTS In the research staff survey, 92% reported the overall activity taught them something new; 98% reported it provided valuable feedback; 100% said they would like to participate again. In the SP evaluation there was significant variation: the percent well-done of items by case ranged from 25-85%. CONCLUSIONS Results from this pilot suggest that GOSCEs are a (1) acceptable; (2) low cost; and (3) differentiating mechanism for training and assessing research staff in communication skills and structural competency necessary for participant research recruitment.
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Affiliation(s)
- Harriet Fisher
- Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine (NYUGSOM), New York, USA.
| | - Sondra Zabar
- grid.137628.90000 0004 1936 8753Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine (NYUGSOM), New York, USA
| | - Joshua Chodosh
- grid.137628.90000 0004 1936 8753Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York, USA ,grid.137628.90000 0004 1936 8753Division of Geriatric Medicine, NYU Grossman School of Medicine (NYUGSOM), New York, USA
| | - Aisha Langford
- grid.137628.90000 0004 1936 8753Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York, USA
| | - Chau Trinh-Shevrin
- grid.137628.90000 0004 1936 8753Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York, USA
| | - Scott Sherman
- grid.137628.90000 0004 1936 8753Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York, USA
| | - Lisa Altshuler
- grid.137628.90000 0004 1936 8753Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine (NYUGSOM), New York, USA
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Simon CM, Wang K, Shinkunas LA, Stein DT, Meissner P, Smith M, Pentz R, Klein DW. Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes. J Empir Res Hum Res Ethics 2022; 17:144-166. [PMID: 34410195 PMCID: PMC8712348 DOI: 10.1177/15562646211038819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some individuals' understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations.
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Affiliation(s)
| | - Kai Wang
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Rebecca Pentz
- School of Medicine, Emory University, Atlanta, GA, USA
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Phan L, Kuo CCL, Fryer CS, Smith-Bynum MA, Clark PI, Butler J. 'We're not gonna have a big quit if loose ones are around': urban, African American smokers' beliefs concerning single cigarette use reduction. HEALTH EDUCATION RESEARCH 2022; 36:422-433. [PMID: 34357385 PMCID: PMC9115374 DOI: 10.1093/her/cyab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/02/2021] [Indexed: 06/13/2023]
Abstract
Single cigarette use (i.e. loosies, loose ones, singles) poses risks for smoking continuation among urban, African American smokers. There is, however, limited research to inform health education interventions addressing this behavior. We conducted 25 in-depth interviews with urban, African American users (ages 20-58 years) from Baltimore, MD and the District of Columbia in June and July 2018 to assess their beliefs about reducing single cigarette use. Interviews were guided by the Health Belief Model and its constructs of perceived benefits, perceived barriers, perceived susceptibility, perceived severity and self-efficacy. We analyzed qualitative data using framework analysis. Perceived benefits of reducing single cigarette use involved the avoidance of health risks, including concerns about buying fake cigarettes and exposure to unknown personal hygiene practices from sellers. Perceived barriers were the convenience of buying singles due to their availability, accessibility and low cost. Participants shared they were willing to use cognitive behavioral strategies to reduce their purchasing and use of singles. This study provides insights on potential intervention targets related to beliefs towards reducing single cigarette use. These findings can inform enforcement policies and health education interventions targeting single cigarette use among urban, African American smokers who use singles.
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Affiliation(s)
| | - Charlene Chao-Li Kuo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742, USA
- Maryland Center for Health Equity, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Mia A Smith-Bynum
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Pamela I Clark
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - James Butler
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD 20742, USA
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9
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Harle CA, Golembiewski EH, Rahmanian KP, Brumback B, Krieger JL, Goodman KW, Mainous AG, Moseley RE. Does an interactive trust-enhanced electronic consent improve patient experiences when asked to share their health records for research? A randomized trial. J Am Med Inform Assoc 2020; 26:620-629. [PMID: 30938751 DOI: 10.1093/jamia/ocz015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 01/26/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the context of patient broad consent for future research uses of their identifiable health record data, we compare the effectiveness of interactive trust-enhanced e-consent, interactive-only e-consent, and standard e-consent (no interactivity, no trust enhancement). MATERIALS AND METHODS A randomized trial was conducted involving adult participants making a scheduled primary care visit. Participants were randomized into 1 of the 3 e-consent conditions. Primary outcomes were patient-reported satisfaction with and subjective understanding of the e-consent. Secondary outcomes were objective knowledge, perceived voluntariness, trust in medical researchers, consent decision, and time spent using the application. Outcomes were assessed immediately after use of the e-consent and at 1-week follow-up. RESULTS Across all conditions, participants (N = 734) reported moderate-to-high satisfaction with consent (mean 4.3 of 5) and subjective understanding (79.1 of 100). Over 94% agreed to share their health record data. No statistically significant differences in outcomes were observed between conditions. Irrespective of condition, black participants and those with lower education reported lower satisfaction, subjective understanding, knowledge, perceived voluntariness, and trust in medical researchers, as well as spent more time consenting. CONCLUSIONS A large majority of patients were willing to share their identifiable health records for research, and they reported positive consent experiences. However, incorporating optional additional information and messages designed to enhance trust in the research process did not improve consent experiences. To improve poorer consent experiences of racial and ethnic minority participants and those with lower education, other novel consent technologies and processes may be valuable. (An Interactive Patient-Centered Consent for Research Using Medical Records; NCT03063268).
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Affiliation(s)
- Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | | | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida, USA
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
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Phan L, Beck K, Wang MQ, Butler J. The Development and Initial Validation of a Health Belief Model Scale to Reduce Single Cigarette Use among Urban, African American Smokers. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1795755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Min Qi Wang
- University of Maryland School of Public Health
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Chiu RG, Murphy BE, Zhu A, Mehta AI. Racial and Ethnic Disparities in the Inpatient Management of Primary Spinal Cord Tumors. World Neurosurg 2020; 140:e175-e184. [DOI: 10.1016/j.wneu.2020.04.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
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12
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Asare M, Heckler CE, Culakova E, Kamen CS, Kleckner AS, Minasian LM, Wendler DS, Feige M, Weil CJ, Long J, Cole SK, Onitilo AA, Peppone LJ, Morrow GR, Janelsins MC. Racial/Ethnic Differences in Comprehension of Biospecimen Collection: a Nationwide University of Rochester Cancer Center NCI Community Oncology Research Program Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:292-300. [PMID: 30612315 PMCID: PMC6612536 DOI: 10.1007/s13187-018-1464-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To examine whether (a) non-minority participants differed from racial minority participants in the understanding of biospecimens collected for research purposes, (b) patients differed from comparison group in their understanding of the ways their biospecimens could be used by researchers, and (c) participants received adequate information before consenting to donate blood for research studies. We analyzed cross-sectional data from female breast cancer patients scheduled to receive chemotherapy at the National Cancer Institute (NCI) Community Oncology Research Program (NCORP) clinical sites and a healthy comparison group. After reading a consent form related to biospecimens and consenting to participate in a clinical trial, participants' understanding of biospecimen collection was evaluated. Linear models were used to compare scores between non-minority and racial minority participants as well as cancer and non-cancer comparisons adjusting for possible confounding factors. A total of 650 participants provided evaluable data; 592 were non-minority (Caucasian) and 58 participants were a racial minority (71% Black and 29% other). There were 427 cancer patients and 223 comparisons. Non-minority participants scored higher than racial minorities on relevance-to-care items (diff. = 0.48, CI 0.13-0.80, p = 0.001). Comparison group scored higher than cancer patients on relevance-to-care items (diff. = 0.58, CI 0.37-0.78). A moderate number of the participants exhibited a poor understanding of biospecimen collection across all racial/ethnic backgrounds, but racial minority participants' scores remained lower in the relevance-to-care subscale even after adjusting for education and reading level. Differences were also noted among the patients and comparison group. Researchers should facilitate comprehension of biospecimen collection for all study participants, especially racial minority participants.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place, Waco, TX, 97343, USA.
| | - Charles E Heckler
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Eva Culakova
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Charles S Kamen
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Amber S Kleckner
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Michelle Feige
- Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP), Washington, DC, USA
| | - Carol J Weil
- National Cancer Institute (NCI), Bethesda, MD, USA
| | - Joan Long
- Cancer Research Consortium of West Michigan NCORP, Grand Rapids, MI, USA
| | | | | | - Luke J Peppone
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary R Morrow
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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13
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Mihaela Micheu M, Udrea OM, Octavia Popa M, Rusu I, Gheorghe-Fronea O, Scafa-Udriste A, Dorobantu M. The Attitude of Patients from a Romanian Tertiary Cardiology Center as Regards Participation in Biomarker-Based Clinical Trials - Survey Methodology. J Med Life 2019; 11:320-327. [PMID: 30894889 PMCID: PMC6418342 DOI: 10.25122/jml-2018-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the challenges faced when conducting a clinical trial is the recruitment of the proposed number of participants. Accordingly, identifying barriers to patients’ enrollment and developing effective strategies to overcome them is mandatory. One of the main strategies employed to improve participation rate consists of designing the informed consent forms based on patients’ feedback. This survey aims to explore the attitude of patients admitted in a Romanian tertiary cardiology center to take part in biomarker-based clinical trials. This is a descriptive, prospective and longitudinal single-center study. Participants will be recruited until the planned sample size will be reached (n=333). The patients will be interviewed based on a semi-structured questionnaire which includes four sections: demographics (7 items), personal medical history (7 items), attitudes (9 items) and trust (4 items). Descriptive statistics will be used to illustrate patients’ demographics, medical history, attitudes toward biomarker-based clinical trials and trust in medical researchers. Logistic regression models will be employed to assess relations between patients’ attitudes, trust, and different socio-demographic variables. Data analysis will offer answers to key questions addressed by this survey: What amount of and in what form should information be disclosed? Who should make the invitation to participate? The information gained will facilitate tailoring informed consent forms to suit the needs of patients with various demographic, social and educational backgrounds.
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Affiliation(s)
- Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Oana-Maria Udrea
- Department of Psychology, "Grigore Alexandrescu" Clinical Hospital of Bucharest, Bucharest, Romania
| | | | - Iulia Rusu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Oana Gheorghe-Fronea
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Maria Dorobantu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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14
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Pol S, Fox-Lewis S, Neou L, Parker M, Kingori P, Turner C. If you come from a well-known organisation, I will trust you: Exploring and understanding the community's attitudes towards healthcare research in Cambodia. PLoS One 2018; 13:e0195251. [PMID: 29668693 PMCID: PMC5905956 DOI: 10.1371/journal.pone.0195251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore Cambodian community members' understanding of and attitudes towards healthcare research. DESIGN This qualitative study generated data from semi-structured interviews and focus group discussions. This study was conducted at a non-governmental paediatric hospital and in nearby villages in Siem Reap province, Cambodia. A total of ten semi-structured interviews and four focus group discussions were conducted, involving 27 participants. Iterative data collection and analysis were performed concurrently. Data were analysed by thematic content analysis and the coding structure was developed using relevant literature. RESULTS Participants did not have a clear understanding of what activities related to research compared with those for routine healthcare. Key attitudes towards research were responsibility and trust: personal (trust of the researcher directly) and institutional (trust of the institution as a whole). Villagers believe the village headman holds responsibility for community activities, while the village headman believes that this responsibility should be shared across all levels of the government system. CONCLUSIONS It is essential for researchers to understand the structure and relationship within the community they wish to work with in order to develop trust among community participants. This aids effective communication and understanding among all parties, enabling high quality ethical research to be conducted.
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Affiliation(s)
- Sreymom Pol
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Shivani Fox-Lewis
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Patricia Kingori
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Angkor Hospital for Children, Siem Reap, Cambodia
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Garza MA, Quinn SC, Li Y, Assini-Meytin L, Casper ET, Fryer CS, Butler J, Brown NA, Kim KH, Thomas SB. The Influence of Race and Ethnicity on Becoming a Human Subject: Factors Associated with Participation in Research. Contemp Clin Trials Commun 2017; 7:57-63. [PMID: 29226266 PMCID: PMC5716487 DOI: 10.1016/j.conctc.2017.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Inroduction The purpose of this study was to explore factors associated with willingness of African Americans and Latinos to participate in biomedical and public health research and to delineate factors that influence the decision to become a human subject. Methods We present results from a 2010 random digit-dial telephone survey of 2,455 African American (N = 1191) and Latino (N = 1264) adults. We used standard measures to assess knowledge of research, terminology, informed consent procedures, previous participation in research, health care experiences, social support, risk perception, religiousness, and trust. Results Over 60% of both African Americans and Latinos reported they believed people in medical research are pressured into participating. Over 50% said that it was not at all important to have someone of the same race/ethnicity ask them to participate. In a sub-sample of 322 African Americans and 190 Latinos who had previously been asked to participate in a research study, 63% of African Americans and 65% of Latinos consented to participate in a study. Finally, both African Americans (57%) and Latinos (68%) reported willingness to participate in future research. Overall, the multivariate analysis explained 29% of the variability in willingness to participate in future research. Conclusions Results suggest that African Americans and Latinos have no automatic predisposition to decline participation in research studies. These results can inform culturally tailored interventions for ethical recruitment of minorities into research and clinical trials.
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Affiliation(s)
- Mary A Garza
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Sandra Crouse Quinn
- Department of Family Science; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Yan Li
- Joint Program in Survey Methodology & Department of Epidemiology and Biostatistics, University of Maryland, College Park
| | - Luciana Assini-Meytin
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Erica T Casper
- Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Craig S Fryer
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - James Butler
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Natasha A Brown
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Kevin H Kim
- Department of Behavioral and Community Health; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
| | - Stephen B Thomas
- Department of Health Services Administration; Maryland Center for Health Equity, School of Public Health, University of Maryland College Park
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McCord AL. Ethical considerations for involving Latina adolescents in mental health research. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:47-53. [PMID: 28463436 DOI: 10.1111/jcap.12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Abstract
TOPIC US Latina adolescents experience significant mental health disparities, such as depressive symptoms and suicidal ideation and, therefore, should be involved in research studies focused on minimizing these health disparities. However, researchers must consider the specific ways this population is vulnerable and provide adequate protections to reduce risks related to these vulnerabilities. PURPOSE The purpose of this article is to describe the different ways that Latina adolescents with mental health problems can be vulnerable research participants, identify strategies to protect this population during a research study, and describe steps taken to apply these strategies in an ongoing qualitative study examining depression in Latina adolescents. SOURCES USED Kipnis's (2003) article describes seven ways that children can be vulnerable research participants. These seven vulnerabilities are used to describe the vulnerabilities of Latina adolescents with mental health problems. Specific strategies to protect this population are synthesized to provide a list of strategies that can be used by researchers to reduce the risks associated with the vulnerabilities of this group. CONCLUSIONS In order to minimize risks for Latina adolescents, researchers must be engaged in Latino/a communities, use culturally and linguistically appropriate consent processes, and implement strategies to protect the confidentiality of Latina adolescent participants.
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Graves D, Sheldon JP. Recruiting African American Children for Research: An Ecological Systems Theory Approach. West J Nurs Res 2017; 40:1489-1521. [PMID: 28436265 DOI: 10.1177/0193945917704856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With health disparities still pervasive and persistent in the United States, medical researchers and social scientists continue to develop recruitment strategies to increase the inclusion of racial/ethnic minority groups in research and interventions. Effective methods for recruiting samples of African American participants for pediatric research may be best understood when situated within an overarching conceptual model-one that serves to organize and explain effective recruitment strategies. A theoretical framework well suited for this purpose is Bronfenbrenner's ecological systems theory, which views individuals as influencing and being influenced by (both directly and indirectly) a series of interconnected social systems. Based on the ecological systems theory and on previous research from multiple domains (e.g., medicine, psychology, public health, social work), in the current article, we review strategies for effective recruitment of African American children and adolescents for research.
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Eisenhauer ER, Arslanian-Engoren C. Religious Values and Biobanking Decisions: An Integrative Review. Res Theory Nurs Pract 2016; 30:104-23. [PMID: 27333632 DOI: 10.1891/1541-6577.30.2.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Biobanking may include research procedures that violate the religious values and preferences of some patients. This integrative literature review evaluated the influence of religious values on participants' decisions to donate biospecimens to biobanks for research. The review followed the method of Whittemore and Knafl (2005). PubMed, CINAHL, and Google Scholar databases were searched for studies published between January 1, 1994 and March 31, 2014. The influence of religious values on decision making in biobanking included the following themes: (a) religious prohibitions, (b) pursuit of health, (c) decisional conflict, and (d) scope of consent. Participants' decisions reflected that they wanted to benefit from scientific advancements and to help others but wanted to do so in accordance with their religious values. The consideration of religious values in decisions about biobanking is an international phenomenon occurring across cultures. Limiting the scope of consent may help to accommodate religious values and preferences. Researchers need to respect the religious values of patients by fully explaining the implications of research procedures in biobanking. Nurses should advocate for the consideration of patients' religious values in this new age of technological advancements.
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Fisher CB, Arbeit MR, Dumont MS, Macapagal K, Mustanski B. Self-Consent for HIV Prevention Research Involving Sexual and Gender Minority Youth: Reducing Barriers Through Evidence-Based Ethics. J Empir Res Hum Res Ethics 2016; 11:3-14. [PMID: 26956988 PMCID: PMC4842126 DOI: 10.1177/1556264616633963] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project examined the attitudes of sexual and gender minority youth (SGMY) toward guardian permission for a pre-exposure prophylaxis (PrEP) adherence trial and their preparedness to provide informed, rational, and voluntary self-consent. Sixty sexually active SGMY (ages 14-17) participated in online survey and asynchronous focus group questions after watching a video describing a PrEP adherence study. Youth responses highlighted guardian permission as a significant barrier to research participation, especially for those not "out" to families. Youth demonstrated understanding of research benefits, medical side effects, confidentiality risks, and random assignment and felt comfortable asking questions and declining participation. Reasoning about participation indicated consideration of health risks and benefits, personal sexual behavior, ability to take pills every day, logistics, and post-trial access to PrEP. Results demonstrate youth's ability to self-consent to age- and population-appropriate procedures, and underscore the value of empirical studies for informing institutional review board (IRB) protections of SGMY research participants.
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Picillo M, Kou N, Barone P, Fasano A. Recruitment strategies and patient selection in clinical trials for Parkinson's disease: Going viral and keeping science and ethics at the highest standards. Parkinsonism Relat Disord 2015; 21:1041-8. [PMID: 26228079 DOI: 10.1016/j.parkreldis.2015.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Enrollment of an adequate number of suitable candidates is a critical component of good quality randomized controlled trials (RCTs). Parkinson's disease (PD) is a highly heterogeneous disease and recruiting a large and homogeneous sample of patients is often challenging. Further, PD patients are often elderly, cognitively impaired and disabled, thus requiring the assistance from their caregivers for participation in RCTs. Only a limited number of studies have explored the effectiveness of recruitment strategies and PD patient selection in clinical trials. We aim to review the four crucial recruitment components of RCTs (i.e. infrastructure, nature of the research, recruiter characteristics and participant characteristics) with particular implications in PD, and to explore strategies to improve recruitment and patient selection in RCTs in PD. CONCLUSION Movement disorders centers have a key role in managing recruitment and patient selection in RCTs in PD. Key recommendations within the infrastructure component are to improve trust and communication between patient and participant, and to consider the diversity, perceived disadvantages, and health care accessibility of the participants. Further, study designs that involve participant's opinions and considers placebo and lessebo effects are highly recommended for the nature of the research component of RCTs. Finally, a team-based approach with recruiters and participants that establishes relationships between researchers and the community and addresses ethical considerations are encouraged as part of the recruiters and participants components. Finally, we envisage a greater usage of internet-based strategies for clinical trials recruitment in PD with the goal of 'going viral' with the recruitment.
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Affiliation(s)
- Marina Picillo
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada; Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nancy Kou
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Paolo Barone
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada.
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Yoshizawa RS, Osis MJD, Nascimento SL, Bento SF, Godoy AC, Coelho S, Cecatti JG. Postpartum Women's Perspectives on the Donation of Placentas for Scientific Research in Campinas, Brazil. J Empir Res Hum Res Ethics 2014; 10:76-87. [PMID: 25742669 DOI: 10.1177/1556264614559889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about public perspectives of scientific and therapeutic uses of placentas. Gaps in knowledge potentiate ethical and clinical problems regarding collection and applications. As such, this study sought to assess the perspectives of placenta donation of a sample of women. Postpartum women's perspectives on placental donation were assessed at the State University of Campinas in the Centro de Atençäo Integral a Saúde da Mulher (CAISM) maternity hospital using a cross-sectional survey (n = 384) and semi-structured interviews (n = 12). Surveys were analyzed quantitatively and interviews were analyzed qualitatively using grounded coding; results were compared. The average age of respondents was 27. Fifty-six percent had more than one child, 45% were Caucasian, 38% were mixed-race, 74% identified with a Christian faith, 52% had high school education or higher, 13% regarded the placenta as spiritually important, 72% felt that knowing what happens to the placenta after birth was somewhat or very important, 78% supported the use of the placenta in research and medicine, 59% reported that consent to collect the placenta was very or somewhat important, 78% preferred their doctor to invite donation, and only 7% preferred the researcher to invite donation. Interviews suggested women appreciate being part of research and that receiving information about studies was important to them. Informed by these results, we argue that women support scientific and therapeutic uses of placentas, want to be included in decision making, and desire information about the placenta. Placentas should not be viewed as "throwaway" organs that are poised for collection without the involvement and permission of women. Women want to be meaningfully included in research processes.
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Affiliation(s)
| | | | | | | | | | - Suelene Coelho
- State University of Campinas, State of Sao Paulo, Brazil
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Kupersmith J, LaBarca D. Using comparative effectiveness research to remedy health disparities. J Comp Eff Res 2014; 3:177-84. [DOI: 10.2217/cer.14.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Health disparities are an important and continuing problem of considerable research importance. Comparative effectiveness research (CER) is an excellent vehicle to evaluate interventions to remedy disparities. We classify CER for disparities at three levels of science: basic biology, care and systems, and social and cultural context. In basic biology, genomics will delineate treatments for specific individuals and populations. Care and systems interventions are most important research areas to improve process and quality measures. However, there is evidence that correction of healthcare processes disparities will not be sufficient to improve health and that social and cultural research may be key in this regard. The methodology of CER for disparities is the same as that of other research with randomized controlled trials the gold standard and database analysis, and other observational and quasi-experimental methods important and effective. In addition, mixed methods and multilevel modeling offer promise. Community involvement in research and patient preferences among high-quality choices need to be included in planning of CER.
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Affiliation(s)
- Joel Kupersmith
- Georgetown University Medical Center, Washington, DC, USA
- Kupersmith Associates, Washington, DC, USA
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Recruiting for epigenetic research: facilitating the informed consent process. Nurs Res Pract 2013; 2013:935740. [PMID: 23840949 PMCID: PMC3690242 DOI: 10.1155/2013/935740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022] Open
Abstract
Because the effects of epigenetic (gene-environment interaction) changes have been associated with numerous adverse health states, the study of epigenetic measures provides exciting research opportunities for biobehavioral scientists. However, recruitment for studies focusing on any aspect of genetics poses challenges. Multiple factors, including lack of knowledge regarding a research study, have been identified as barriers to recruitment. Strengthening the informed consent process through extended discussion has been found to be effective in recruiting for research studies in general, yet there is a paucity of information that focused on such a recruitment strategy for epigenetic studies. In this paper, we share our experiences with strategies to strengthen the informed consent process as well as provide samples of materials developed to heighten potential participants' understanding of epigenetics, in 4 epigenetic research studies with women from diverse backgrounds experiencing a range of health issues. The combined enrollment success rate for epigenetic studies using the process was 89% with participants representing a diverse population. We posit that carefully developed recruitment scripts provided a foundation for improving potential participants' understanding of the research project. Easy to understand illustrations of the epigenetic process provided a basis for active engagement and encouraged individual questions.
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