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Avery J, Bell JAH, Baryolay K, Rodin G, Nissim R, Balneaves LG. Decision-making and autonomy among participants in early-phase cancer immunotherapy trials: a qualitative study. BMC Cancer 2024; 24:373. [PMID: 38528488 DOI: 10.1186/s12885-024-12119-7] [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: 08/24/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Participants considering early-phase cancer clinical trials (CTs) need to understand the unique risks and benefits prior to providing informed consent. This qualitative study explored the factors that influence patients' decisions about participating in early-phase cancer immunotherapy CTs through the ethical lens of relational autonomy. METHODS Using an interpretive descriptive design, interviews were conducted with 21 adult patients with advanced cancer who had enrolled in an early-phase CT. Data was analyzed using relational autonomy ethical theory and constant comparative analysis. RESULTS The extent to which participants perceived themselves as having a choice to participate in early-phase cancer immunotherapy CTs was a central construct. Perceptions of choice varied according to whether participants characterized their experience as an act of desperation or as an opportunity to receive a novel treatment. Intersecting psychosocial and structural factors influenced participants' decision making about participating in early-phase cancer immunotherapy trials. These relational factors included: (1) being provided with hope; (2) having trust; (3) having the ability to withdraw; and (4) timing constraints. CONCLUSIONS Findings highlight the continuum of perceived choice that exists among patients with cancer when considering participation in early-phase cancer immunotherapy CTs. All participants were interpreted as exhibiting some degree of relational autonomy within the psychosocial and structural context of early-phase CT decision making. This study offers insights into the intersection of cancer care delivery, personal beliefs and values, and established CT processes and structures that can inform future practices and policies associated with early-phase cancer immunotherapy CTs to better support patients in making informed decisions.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer A H Bell
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.
- The Institute for Education Research, University Health Network, Toronto, ON, Canada.
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Princess Margaret Cancer Centre, Department of Supportive Care, Research Division, 700 Bay St., 23rd Floor, Toronto, ON, M5G 1Z6, Canada.
| | - Khotira Baryolay
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cancer Experience, University Health Network Cancer Program, University Health Network, Toronto, ON, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lynda G Balneaves
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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Wilson MA, Fouts BL, Brown KN. Development of a mobile application for acute pain management in U.S. military healthcare. Appl Nurs Res 2021; 58:151393. [PMID: 33745549 DOI: 10.1016/j.apnr.2020.151393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
One of the most significant challenges faced by the U.S. military health system is effective pain management. In resource-denied environments such as En Route Care (ERC), patient care begins with effective acute pain management and is vital to ensure optimal long-term patient outcomes. An electronic, mobile pain management application (app) called the Bee Better app was developed to address the gaps in acute pain management for patients transported throughout the ERC system. The app enables patients to track self-reported acute pain data, provides education and evidenced-based non-pharmacologic interventions during transport. The Delphi method was used as a novel approach to solicit feedback from subject matter experts to systematically enhance the app development process. In its current state, the app tracks patients' reported pain data and information regarding medication intake and provides educational resources about medications and the flight environment. Optimally in the future, the app will deliver real-time therapeutic pain interventions, integrate with the electronic health record and communicate with providers in real-time during care, enabling better patient-centered pain management in the austere ERC environment. Initial usability scores were above industry standards indicating a potential benefit in using a rigorous process for healthcare app development. These mobile apps may enable increased self-management and autonomy in resource-limited environments and optimize outcomes of acute pain management.
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Affiliation(s)
- Melissa A Wilson
- 711th Human Performance Wing, Air Force Research Laboratory, En Route Care Research, 2510 5th Street, Bldg 840, Wright-Patterson AFB, OH 45433, United States of America.
| | - Brittany L Fouts
- 711th Human Performance Wing, Air Force Research Laboratory, Medical Plans and Programs, 2610 7th Street, Bldg 441, Wright-Patterson AFB, OH 45433, United States of America
| | - Kayla N Brown
- 711th Human Performance Wing, Air Force Research Laboratory, En Route Care Research, 2510 5th Street, Bldg 840, Wright-Patterson AFB, OH 45433, United States of America
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Bell JAH, Kelly MT, Gelmon K, Chi K, Ho A, Rodney P, Balneaves LG. Gatekeeping in cancer clinical trials in Canada: The ethics of recruiting the "ideal" patient. Cancer Med 2020; 9:4107-4113. [PMID: 32314549 PMCID: PMC7300392 DOI: 10.1002/cam4.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 01/11/2023] Open
Abstract
Background Perspectives of clinical trial (CT) personnel on accrual to oncology CTs are relatively absent from the literature. This study explores CT personnel's experience recruiting patients to oncology CTs. Methods A qualitative study design was utilized. In‐depth, individual interviews with 12 oncology CT personnel were conducted, including six CT nurses and six physician‐investigators. Interviews were digitally recorded and transcribed verbatim. Data were subjected to thematic and ethical analysis to identify key concepts and themes. Results CT personnel reported considering two ethical commitments in CT recruitment: maintaining trial integrity and ensuring patient autonomy through obtaining informed consent. The process of gatekeeping emerged as a way to navigate these ethical commitments during CT accrual. Gatekeeping was influenced by: (a) perceptions of patients’ personal suitability for a trial, and (b) healthcare resources and infrastructure. CT personnel's discernment of personal suitability was influenced by patients’ cognitive and mental health status, language and cultural background, geographic location, family support, and disease status. Three structural factors impacted gatekeeping: complexity of CTs, consent process, and time limitations in the healthcare system. CT personnel experienced most factors as constraints to accrual and gaining patients’ informed consent. Conclusion CT personnel discussed navigating ethical challenges in CT recruitment by offering enrollment to specific patient populations, exacerbating other ethical tensions. Systems‐level strategies are needed to address barriers to ethical CT recruitment. Future research should investigate the role of policies and/or tools (eg, decision aids) to support patients and CT personnel's discussions about CT participation, promote more ethical recruitment, and potentially increase accrual.
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Affiliation(s)
- Jennifer A H Bell
- University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Karen Gelmon
- University of British Columbia, Vancouver, BC, Canada
| | - Kim Chi
- University of British Columbia, Vancouver, BC, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, BC, Canada.,University of California, Oakland, CA, USA.,Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
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