1
|
Chiumento A, Fovargue S, Redhead C, Draper H, Frith L. Delivering compassionate NHS healthcare: A qualitative study exploring the ethical implications of resetting NHS maternity and paediatric services following the acute phase of the COVID-19 pandemic. Soc Sci Med 2024; 344:116503. [PMID: 38324977 DOI: 10.1016/j.socscimed.2023.116503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 02/09/2024]
Abstract
A distinction can be drawn between healthcare, where compassion is evident, and the functional delivery of health services. Measures to curb the spread of COVID-19, such as personal protective equipment, telehealth, and visiting restrictions created barriers to service delivery and put pressure on healthcare. Through 37 qualitative interviews with NHS senior managers (n = 11), health professionals (n = 26), and 5 focus group discussions with members of the public (n = 26), we explored experiences of the everyday ethical tensions created as services were being re-established following the acute phase of the COVID-19 pandemic in England. Our analysis enriches an understanding of compassionate care as outlined in NHS operational documents - covering the emotional, moral, and relational components of healthcare beyond the functionalities of treatment. From this analysis, we consider the normative standards underpinning NHS healthcare, concluding that, wherever possible, offering compassionate healthcare to patients and their families should be facilitated, and health professionals should themselves be compassionately supported in the workplace. Our findings foreground the need to consider the consequences of the short-term adoption of a functional treatment approach, including strategies that support health professionals and inform the public, to avoid the long-term damage caused by the fracturing of compassionate healthcare.
Collapse
Affiliation(s)
- Anna Chiumento
- School of Social and Political Sciences, University of Edinburgh, United Kingdom.
| | - Sara Fovargue
- School of Law, University of Sheffield, United Kingdom
| | - Caroline Redhead
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, United Kingdom
| | - Heather Draper
- Warwick Medical School, The University of Warwick, United Kingdom
| | - Lucy Frith
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, United Kingdom
| |
Collapse
|
2
|
Moorlock G, Asgari E, Callaghan C, Draper H, Dupont P, Gilbert P, Nasralla D, Veitch P, Watson C, O'Neill S. The British Transplantation Society guidelines on ethics, law and consent in relation to deceased donors after circulatory death. Transplant Rev (Orlando) 2024; 38:100803. [PMID: 37919138 DOI: 10.1016/j.trre.2023.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
The British Transplantation Society (BTS) 'Guideline on transplantation from deceased donors after circulatory death' has recently been updated and this manuscript summarises the relevant recommendations from chapters specifically related to law, ethics, donor consent and informing the recipient.
Collapse
Affiliation(s)
| | | | | | | | | | - Patty Gilbert
- Northern Ireland Kidney Patients' Association, Belfast, UK
| | | | | | | | | |
Collapse
|
3
|
Zuchowski M, Mamode N, Draper H, Gogalniceanu P, Norton S, Chilcot J, Auburn T, Clarke A, Williams L, Burnapp L, McCrone P, Maple H. Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study. Transpl Int 2023; 36:11258. [PMID: 37359823 PMCID: PMC10285071 DOI: 10.3389/ti.2023.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
Unspecified kidney donation (UKD) has made substantial contributions to the UK living donor programme. Nevertheless, some transplant professionals are uncomfortable with these individuals undergoing surgery. This study aimed to qualitatively explore the attitudes of UK healthcare professionals towards UKD. An opportunistic sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering six UK transplant centres: three high volume and three low volume centres. Interview transcripts were analysed using inductive thematic analysis. The study provided comprehensive coverage of the UK transplant community, involving 59 transplant professionals. We identified five themes: staff's conception of the ethics of UKD; presence of the known recipient in the donor-recipient dyad; need for better management of patient expectations; managing visceral reactions about the "typical" unspecified kidney donor; complex attitudes toward a promising new practice. This is the first in-depth qualitative study of attitudes of transplant professionals towards UKD. The data uncovered findings with strong clinical implications for the UKD programme, including the need for a uniform approach towards younger candidates that is adhered to by all transplant centres, the need to equally extend the rigorous assessment to both specified and unspecified donors, and a new approach to managing donor expectations.
Collapse
Affiliation(s)
- Mira Zuchowski
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter Gogalniceanu
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Timothy Auburn
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Alexis Clarke
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lynsey Williams
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lisa Burnapp
- Directorate of Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Watford, United Kingdom
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Hannah Maple
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
4
|
Moorlock G, Draper H. Proposal to support making decisions about the organ donation process. J Med Ethics 2023; 49:434-438. [PMID: 35953297 DOI: 10.1136/jme-2022-108323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/07/2022] [Indexed: 05/24/2023]
Abstract
In this paper, we propose a novel approach to permit members of the public opportunity to record more nuanced wishes in relation to organ donation. Recent developments in organ donation and procurement have made the associated processes potentially more multistaged and complex than ever. At the same time, opt-out legislation has led to a more simplistic recording of wishes than ever. We argue that in order to be confident that a patient would really wish to go ahead with the various interventions and procedures that now accompany organ donation, more nuanced information than a simple 'yes' or 'no' may be required. This is of particular importance for donation after circulatory death, where some interventions to facilitate donation occur when the patient is still alive. We propose the implementation of an online form to allow people to record more nuanced wishes in relation to donation, including an indication of competing wishes and how these should be weighed into decision-making. We argue that this approach will promote autonomous decision-making for the public, potentially reduce difficulties that family members encounter at the time of organ donation, and should make medical staff more confident that they are truly acting according to the wishes and best interests of their patients.
Collapse
Affiliation(s)
- Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
5
|
Maple H, Gogalniceanu P, Gare R, Burnapp L, Draper H, Chilcot J, Norton S, Mamode N. Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study. Transpl Int 2023; 36:11257. [PMID: 37324220 PMCID: PMC10261699 DOI: 10.3389/ti.2023.11257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.
Collapse
Affiliation(s)
- Hannah Maple
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Petrut Gogalniceanu
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rebecca Gare
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lisa Burnapp
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- UK and NHS Blood and Transplant, Bristol, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
Redhead CAB, Fovargue S, Frith L, Chiumento A, Draper H, Baines PB. RELATIONSHIPS, RIGHTS, AND RESPONSIBILITIES: (RE)VIEWING THE NHS CONSTITUTION FOR THE POST-PANDEMIC 'NEW NORMAL'. Med Law Rev 2023; 31:83-108. [PMID: 36018272 PMCID: PMC9969409 DOI: 10.1093/medlaw/fwac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Action needs to be taken to map out the fairest way to meet the needs of all NHS stakeholders in the post-pandemic 'new normal'. In this article, we review the NHS Constitution, looking at it from a relational perspective and suggesting that it offers a useful starting point for such a project, but that new ways of thinking are required to accommodate the significant changes the pandemic has made to the fabric of the NHS. These new ways of thinking should encompass concepts of solidarity, care, and (reciprocal) responsibility, grounded in an acceptance of the importance of relationships in society. To this end, we explore and emphasise the importance of our interconnections as NHS stakeholders and 're-view' the NHS Constitution from a relational perspective, concentrating on the rights and responsibilities it describes for patients and the public as NHS stakeholders. We argue that the NHS Constitution, of which most stakeholders are probably unaware, can be used as a tool to engage us, and to catalyse conversation about how our responsibilities as NHS stakeholders should change in the post-pandemic 'new normal'.
Collapse
Affiliation(s)
| | - Sara Fovargue
- School of Law, The University of Sheffield, Sheffield, UK
| | - Lucy Frith
- School of Law, Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - Anna Chiumento
- Institute of Population Health, Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul B Baines
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
7
|
Rogers WA, Draper H, Carter SM. Reports of new healthcare AI interventions should include systematic ethical evaluations. Bioethics 2022; 36:728-730. [PMID: 35535958 DOI: 10.1111/bioe.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Wendy A Rogers
- Philosophy Department, Macquarie University, Sydney, New South Wales, Australia
| | - Heather Draper
- Primary Care and General Practice, The University of Birmingham, Birmingham, UK
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
8
|
Shearman K, Masters A, Nutt D, Bowman S, Draper H. Acceptability of donor funding for clinical trials in the UK: a qualitative empirical ethics study using focus groups to elicit the views of research patient public involvement group members, research ethics committee chairs and clinical researchers. BMJ Open 2022; 12:e055208. [PMID: 35715186 PMCID: PMC9207757 DOI: 10.1136/bmjopen-2021-055208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The Plutocratic Proposal is a novel method of funding early phase clinical trials where a single donor funds the entire trial and in so doing secures a place on it. The aim of this study was to identify and explore concerns that may be raised by UK research ethics committees (RECs) when reviewing clinical trials funded in this way. DESIGN Empirical ethics combining ethical analysis and qualitative data from three focus groups held online using Frith's symbiotic approach. Data were analysed using inductive thematic approach informed by the study aims and ethical analysis. PARTICIPANTS 22 participants were recruited: 8 research patient public involvement group members, 7 REC chairs and 7 clinical researchers. All were based in the UK. RESULTS With one exception, participants thought the Plutocratic Proposal may be 'all things considered' acceptable, providing their concerns were met, primary of which was upholding scientific integrity. Other concerns discussed related to the acceptability of the donor securing a place on the trial including: whether this was an unfair distribution of benefits, disclosing the identity of the donor as the funder, protecting the donor from exploitation and funding a single study with multiple donors on the same terms. Some misgivings fell outside the usual REC purview: detrimental impact of donors of bad character, establishing the trustworthiness of the matching agency and its processes and optimising research funding and resources. Despite their concerns, participants recognised that because the donor funds the whole trial, others would also potentially benefit from participating. CONCLUSIONS We identified concerns about the Plutocratic Proposal. UK RECs may be open to approving studies if these can be addressed. Existing governance processes will do some of this work, but additional REC guidance, particularly in relation to donors securing a place on the trial, may be necessary to help RECs navigate ethical concerns consistently.
Collapse
Affiliation(s)
- Kirstie Shearman
- Health Sciences, University of Warwick Faculty of Medicine, Coventry, UK
| | | | | | - Simon Bowman
- Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Heather Draper
- Health Sciences, University of Warwick Faculty of Medicine, Coventry, UK
| |
Collapse
|
9
|
Cruz Rivera S, Aiyegbusi OL, Ives J, Draper H, Mercieca-Bebber R, Ells C, Hunn A, Scott JA, Fernandez CV, Dickens AP, Anderson N, Bhatnagar V, Bottomley A, Campbell L, Collett C, Collis P, Craig K, Davies H, Golub R, Gosden L, Gnanasakthy A, Haf Davies E, von Hildebrand M, Lord JM, Mahendraratnam N, Miyaji T, Morel T, Monteiro J, Zwisler ADO, Peipert JD, Roydhouse J, Stover AM, Wilson R, Yap C, Calvert MJ. Ethical Considerations for the Inclusion of Patient-Reported Outcomes in Clinical Research: The PRO Ethics Guidelines. JAMA 2022; 327:1910-1919. [PMID: 35579638 DOI: 10.1001/jama.2022.6421] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Patient-reported outcomes (PROs) can inform health care decisions, regulatory decisions, and health care policy. They also can be used for audit/benchmarking and monitoring symptoms to provide timely care tailored to individual needs. However, several ethical issues have been raised in relation to PRO use. OBJECTIVE To develop international, consensus-based, PRO-specific ethical guidelines for clinical research. EVIDENCE REVIEW The PRO ethics guidelines were developed following the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network's guideline development framework. This included a systematic review of the ethical implications of PROs in clinical research. The databases MEDLINE (Ovid), Embase, AMED, and CINAHL were searched from inception until March 2020. The keywords patient reported outcome* and ethic* were used to search the databases. Two reviewers independently conducted title and abstract screening before full-text screening to determine eligibility. The review was supplemented by the SPIRIT-PRO Extension recommendations for trial protocol. Subsequently, a 2-round international Delphi process (n = 96 participants; May and August 2021) and a consensus meeting (n = 25 international participants; October 2021) were held. Prior to voting, consensus meeting participants were provided with a summary of the Delphi process results and information on whether the items aligned with existing ethical guidance. FINDINGS Twenty-three items were considered in the first round of the Delphi process: 6 relevant candidate items from the systematic review and 17 additional items drawn from the SPIRIT-PRO Extension. Ninety-six international participants voted on the relevant importance of each item for inclusion in ethical guidelines and 12 additional items were recommended for inclusion in round 2 of the Delphi (35 items in total). Fourteen items were recommended for inclusion at the consensus meeting (n = 25 participants). The final wording of the PRO ethical guidelines was agreed on by consensus meeting participants with input from 6 additional individuals. Included items focused on PRO-specific ethical issues relating to research rationale, objectives, eligibility requirements, PRO concepts and domains, PRO assessment schedules, sample size, PRO data monitoring, barriers to PRO completion, participant acceptability and burden, administration of PRO questionnaires for participants who are unable to self-report PRO data, input on PRO strategy by patient partners or members of the public, avoiding missing data, and dissemination plans. CONCLUSIONS AND RELEVANCE The PRO ethics guidelines provide recommendations for ethical issues that should be addressed in PRO clinical research. Addressing ethical issues of PRO clinical research has the potential to ensure high-quality PRO data while minimizing participant risk, burden, and harm and protecting participant and researcher welfare.
Collapse
Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
| | - Jonathan Ives
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rebecca Mercieca-Bebber
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | | | - Jane A Scott
- PRO Center of Excellence, Global Commercial Strategy Organization, Janssen Global Services, Warrington, United Kingdom
| | - Conrad V Fernandez
- Division of Pediatric Haematology-Oncology, IWK Health Care Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew P Dickens
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | | | - Philip Collis
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Kathrine Craig
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | - Hugh Davies
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | | | - Lesley Gosden
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Maria von Hildebrand
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
| | | | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Thomas Morel
- Global Patient-Centred Outcomes Research & Policy, UCB, Belgium, Brussels
| | | | - Ann-Dorthe Olsen Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | | | - Roger Wilson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Consumer Forum, National Cancer Research Institute, London, United Kingdom
- Patient Involvement Network, Health Research Authority, London, United Kingdom
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- Health Data Research United Kingdom, London, United Kingdom
- UK SPINE, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
10
|
van der Laan LE, Garcia-Prats AJ, Schaaf HS, Winckler JL, Draper H, Norman J, Wiesner L, McIlleron H, Denti P, Hesseling AC. Pharmacokinetics and Drug-Drug Interactions of Abacavir and Lamuvudine Co-administered With Antituberculosis Drugs in HIV-Positive Children Treated for Multidrug-Resistant Tuberculosis. Front Pharmacol 2021; 12:722204. [PMID: 34690765 PMCID: PMC8531271 DOI: 10.3389/fphar.2021.722204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022] Open
Abstract
Given the high prevalence of multidrug-resistant (MDR)-TB in high HIV burden settings, it is important to identify potential drug-drug interactions between MDR-TB treatment and widely used nucleoside reverse transcriptase inhibitors (NRTIs) in HIV-positive children. Population pharmacokinetic models were developed for lamivudine (n = 54) and abacavir (n = 50) in 54 HIV-positive children established on NRTIs; 27 with MDR-TB (combinations of high-dose isoniazid, pyrazinamide, ethambutol, ethionamide, terizidone, fluoroquinolones, and amikacin), and 27 controls without TB. Two-compartment models with first-order elimination and transit compartment absorption described both lamivudine and abacavir pharmacokinetics, respectively. Allometric scaling with body weight adjusted for the effect of body size. Clearance was predicted to reach half its mature value ∼ 2 (lamivudine) and ∼ 3 (abacavir) months after birth, with completion of maturation for both drugs at ∼ 2 years. No significant difference was found in key pharmacokinetic parameters of lamivudine and abacavir when co-administered with routine drugs used for MDR-TB in HIV-positive children.
Collapse
Affiliation(s)
- Louvina E. van der Laan
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Anthony J. Garcia-Prats
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pediatrics, Divisions of General Pediatrics and Adolescent Medicine and Global Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jana L. Winckler
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Heather Draper
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Norman
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Anneke C. Hesseling
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
11
|
Rogers WA, Draper H, Carter SM. Evaluation of artificial intelligence clinical applications: Detailed case analyses show value of healthcare ethics approach in identifying patient care issues. Bioethics 2021; 35:623-633. [PMID: 34046918 DOI: 10.1111/bioe.12885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 06/12/2023]
Abstract
This paper is one of the first to analyse the ethical implications of specific healthcare artificial intelligence (AI) applications, and the first to provide a detailed analysis of AI-based systems for clinical decision support. AI is increasingly being deployed across multiple domains. In response, a plethora of ethical guidelines and principles for general AI use have been published, with some convergence about which ethical concepts are relevant to this new technology. However, few of these frameworks are healthcare-specific, and there has been limited examination of actual AI applications in healthcare. Our ethical evaluation identifies context- and case-specific healthcare ethical issues for two applications, and investigates the extent to which the general ethical principles for AI-assisted healthcare expressed in existing frameworks capture what is most ethically relevant from the perspective of healthcare ethics. We provide a detailed description and analysis of two AI-based systems for clinical decision support (Painchek® and IDx-DR). Our results identify ethical challenges associated with potentially deceptive promissory claims, lack of patient and public involvement in healthcare AI development and deployment, and lack of attention to the impact of AIs on healthcare relationships. Our analysis also highlights the close connection between evaluation and technical development and reporting. Critical appraisal frameworks for healthcare AIs should include explicit ethical evaluation with benchmarks. However, each application will require scrutiny across the AI life-cycle to identify ethical issues specific to healthcare. This level of analysis requires more attention to detail than is suggested by current ethical guidance or frameworks.
Collapse
Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Heather Draper
- Health Science, Warwick Medical School, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
12
|
Frith L, Draper H, Fovargue S, Baines P, Redhead C, Chiumento A. Neither 'Crisis Light' nor 'Business as Usual': Considering the Distinctive Ethical Issues Raised by the Contingency and Reset Phases of a Pandemic. Am J Bioeth 2021; 21:34-37. [PMID: 34313575 DOI: 10.1080/15265161.2021.1940363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | - Paul Baines
- University of Warwick Warwick Medical School
| | | | | |
Collapse
|
13
|
Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, Chan AW, Basch E, Bell J, Bennett A, Bhatnagar V, Blazeby J, Bottomley A, Brown J, Brundage M, Campbell L, Cappelleri JC, Draper H, Dueck AC, Ells C, Frank L, Golub RM, Griebsch I, Haywood K, Hunn A, King-Kallimanis B, Martin L, Mitchell S, Morel T, Nelson L, Norquist J, O'Connor D, Palmer M, Patrick D, Price G, Regnault A, Retzer A, Revicki D, Scott J, Stephens R, Turner G, Valakas A, Velikova G, von Hildebrand M, Walker A, Wenzel L. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ Open 2021; 11:e045105. [PMID: 34193486 PMCID: PMC8246371 DOI: 10.1136/bmjopen-2020-045105] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients' symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item's importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
Collapse
Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Madeleine King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Olalekan Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jill Bell
- Oncology Digital Health, AstraZeneca, Gaithersburg, Maryland, USA
| | - Antonia Bennett
- Cancer Outcomes Research Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jane Blazeby
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Bottomley
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Michael Brundage
- Department of Oncology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Joseph C Cappelleri
- Global Biometrics & Data Management-Statistics, Pfizer Inc, New York City, New York, USA
| | | | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | | | | | - Kirstie Haywood
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | | | | | - Thomas Morel
- Patient-Centered Outcomes Research, UCB Pharma, Brussels, Belgium
| | - Linda Nelson
- Value Evidence and Outcomes-Patient Centered Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Josephine Norquist
- Center for Observational Real-world Evidence (CORE), Patient-Centered Endpoints & Strategy, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Michael Palmer
- Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Donald Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jane Scott
- Johnson and Johnson, Janssen Global Services LLC, High Wycombe, UK
| | | | - Grace Turner
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Antonia Valakas
- EMD Serono Inc, Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maria von Hildebrand
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lari Wenzel
- University of California, Irvine, California, USA
| |
Collapse
|
14
|
Chiumento A, Baines P, Redhead C, Fovargue S, Draper H, Frith L. Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review. BMJ Open 2021; 11:e049214. [PMID: 34103322 PMCID: PMC8189755 DOI: 10.1136/bmjopen-2021-049214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS). DESIGN A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. The strength of normative engagement and the quality of the sources were also assessed. SETTING NHS maternity and paediatric surgery services in England. RESULTS Searches conducted 8 September-12 October 2020, and updated in March 2021, identified 48 sources meeting the inclusion criteria. Themes that arose include: staff safety; collaborative working - including mutual dependencies across the healthcare system; reciprocity; and inclusivity in service recovery, for example, by addressing inequalities in service access. Embedded in the theme of staff and patient safety is embracing new ways of working, such as the rapid roll out of telemedicine. On assessment, many sources did not explicitly consider how ethical principles might be applied or balanced against one another. Weaknesses in the policy sources included a lack of public and user involvement and the absence of monitoring and evaluation criteria. CONCLUSIONS Our findings suggest that relationality is a prominent ethical principle informing resetting NHS non-COVID-19 paediatric surgery and maternity services. Sources explicitly highlight the ethical importance of seeking to minimise disruption to caring and dependent relationships, while simultaneously attending to public safety. Engagement with ethical principles was ethics-lite, with sources mentioning principles in passing rather than explicitly applying them. This leaves decision makers and healthcare professionals without an operationalisable ethical framework to apply to difficult reset decisions and risks inconsistencies in decision making. We recommend further research to confirm or refine the usefulness of the reset phase ethical framework developed through our analysis.
Collapse
Affiliation(s)
- Anna Chiumento
- Institute of Population Health Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Paul Baines
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Redhead
- Liverpool Law School, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
| | | | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Frith
- Law and Philosophy, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK
| |
Collapse
|
15
|
Cruz Rivera S, Mercieca-Bebber R, Aiyegbusi OL, Scott J, Hunn A, Fernandez C, Ives J, Ells C, Price G, Draper H, Calvert MJ. The need for ethical guidance for the use of patient-reported outcomes in research and clinical practice. Nat Med 2021; 27:572-573. [PMID: 33664493 DOI: 10.1038/s41591-021-01275-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine, Sydney Medical School, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, Birmingham, UK
| | - Jane Scott
- Janssen Global Services, Johnson & Johnson, High Wycombe, UK
| | | | - Conrad Fernandez
- Division of Haematology-Oncology, IWK Health Care Centre, Halifax, Nova Scotia, Canada
| | - Jonathan Ives
- Bristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Gary Price
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Heather Draper
- Social Science and Systems in Health, University of Warwick, Warwick, UK
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK. .,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK. .,National Institute for Health Research Applied Research Centre West Midlands, Birmingham, UK. .,NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK. .,Health Data Research UK, London, UK.
| |
Collapse
|
16
|
Gibbons A, Bayfield J, Cinnirella M, Draper H, Johnson RJ, Oniscu GC, Ravanan R, Tomson C, Roderick P, Metcalfe W, Forsythe JLR, Dudley C, Watson CJE, Bradley JA, Bradley C. Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews. BMJ Open 2021; 11:e047263. [PMID: 33853805 PMCID: PMC8098938 DOI: 10.1136/bmjopen-2020-047263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation. DESIGN Longitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach. SETTING Completion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide. PARTICIPANTS 101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews. RESULTS LD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients' expectations influenced their recovery and satisfaction with transplant. CONCLUSIONS While cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients' adjustment post-transplant.
Collapse
Affiliation(s)
- Andrea Gibbons
- Department of Psychology, University of Winchester, Winchester, UK
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
| | - Janet Bayfield
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
- Health Psychology Research Unit, Health Psychology Research Ltd, Egham, UK
| | - Marco Cinnirella
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Heather Draper
- Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
| | - Rachel J Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | - Charles Tomson
- Department of Renal Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Paul Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John L R Forsythe
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- Organ Donation and Transplantation, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
- Health Psychology Research Unit, Health Psychology Research Ltd, Egham, UK
| |
Collapse
|
17
|
Zuchowski M, Mamode N, Draper H, Gogalniceanu P, Norton S, Chilcot J, Clarke A, Williams L, Auburn T, Maple H. Experiences of completed and withdrawn unspecified kidney donor candidates in the United Kingdom: An inductive thematic analysis from the BOUnD study. Br J Health Psychol 2021; 26:958-976. [DOI: 10.1111/bjhp.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/23/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Mira Zuchowski
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Nizam Mamode
- Department of Transplantation Guy's and St Thomas' NHS Foundation Trust London UK
| | - Heather Draper
- Health Sciences Warwick Medical School University of Warwick Coventry UK
| | - Peter Gogalniceanu
- Department of Transplantation Guy's and St Thomas' NHS Foundation Trust London UK
| | - Sam Norton
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Joseph Chilcot
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Alexis Clarke
- School of Psychology University of Plymouth Plymouth UK
| | | | | | - Hannah Maple
- Department of Transplantation Guy's and St Thomas' NHS Foundation Trust London UK
| |
Collapse
|
18
|
Baines P, Draper H, Chiumento A, Fovargue S, Frith L. COVID-19 and beyond: the ethical challenges of resetting health services during and after public health emergencies. J Med Ethics 2020; 46:715-716. [PMID: 33067314 PMCID: PMC7656144 DOI: 10.1136/medethics-2020-106965] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Paul Baines
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Draper
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Chiumento
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
19
|
Cunningham TK, Draper H, Bexhell H, Allgar V, Allen J, Mikl D, Phillips K. A double-blinded randomised controlled study to investigate the effect of intraperitoneal levobupivacaine on post laparoscopic pain. Facts Views Vis Obgyn 2020; 12:155-161. [PMID: 33123690 PMCID: PMC7580260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Laparoscopic surgery is the cornerstone of modern gynaecological surgery, with shorter hospital stays and a quicker return to normal activities. However postoperative pain remains problematic. No strategy to reduce phrenic nerve irritation, including heating or humidifying the insufflating gas, alternatives to CO2, and intraperitoneal analgesics, has shown superiority. METHODS 100 women undergoing laparoscopic surgery were randomly allocated, having either 40ml of 0.25% levobupivacaine or 40ml 0.9% sodium chloride solution administered into the peritoneal cavity following surgery. The patients and the main researcher were blinded. All women received standardised anaesthetic and laparoscopic technique, and postoperative pain control including nursing position and nature of analgesia. Postoperative pain was assessed 3 hours, 8 hours, day 1 and day 4/5 postoperatively. RESULTS 100 patients were recruited undergoing surgery for benign causes aged 19-73(mean 40.3±13). There was no difference between the groups for age(p=0.64) or length of operation(p=0.56). There were no adverse events related to use of intraperitoneal instillation. There was a significant reduction in shoulder-tip pain scores in the levobupivacaine group at 3 hours(p=0.04). Furthermore, there was a significant reduction in wound-pain scores in the levobupivacaine group at 8hrs(p=0.04) and at day 4(p=0.04). No difference was found in pelvic pain between the two groups. No significant difference was found in the use of post-operative analgesia. CONCLUSIONS Intraperitoneal instillation of 40ml of levobupivacaine has some benefit in reducing postoperative pain and need for analgesia in the initial hours following gynaecological surgery. However, further well-designed randomised control trials are required to decide the optimum route and concentration of administering local anaesthetic.
Collapse
Affiliation(s)
- TK Cunningham
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - H Draper
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - H Bexhell
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - V Allgar
- Centre for Health and Population Sciences, Hull York Medical School, Hull, United Kingdom, HU6 7RX
| | - J Allen
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - D Mikl
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - K Phillips
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| |
Collapse
|
20
|
Gibbons A, Cinnirella M, Bayfield J, Watson CJE, Oniscu GC, Draper H, Tomson CRV, Ravanan R, Johnson RJ, Forsythe J, Dudley C, Metcalfe W, Bradley JA, Bradley C. Changes in quality of life, health status and other patient‐reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK‐wide programme. Transpl Int 2020; 33:1230-1243. [DOI: 10.1111/tri.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit Royal Holloway University of London London UK
- Department of Psychology University of Winchester Winchester UK
| | - Marco Cinnirella
- Psychology Department Royal Holloway University of London London UK
| | - Janet Bayfield
- Health Psychology Research Unit Royal Holloway University of London London UK
| | - Christopher J. E. Watson
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Gabriel C. Oniscu
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - Heather Draper
- Health Sciences Warwick Medical School University of Warwick Coventry UK
| | | | - Rommel Ravanan
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | | | - John Forsythe
- Transplant Unit Royal Infirmary of Edinburgh Edinburgh UK
- Organ Donation and Transplantation NHS Blood and Transplant Bristol UK
| | - Chris Dudley
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - J. Andrew Bradley
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Clare Bradley
- Health Psychology Research Unit Royal Holloway University of London London UK
- Health Psychology Research Ltd Egham UK
| |
Collapse
|
21
|
Jenkins SP, Calvert MJ, Draper H. Potential research participants' use of information during the consent process: A qualitative pilot study of patients enrolled in a clinical trial. PLoS One 2020; 15:e0234388. [PMID: 32555664 PMCID: PMC7302495 DOI: 10.1371/journal.pone.0234388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 05/25/2020] [Indexed: 11/27/2022] Open
Abstract
There is increasing evidence that clinical trial participants are uninformed about the trials in which they participate, raising ethical concerns regarding informed consent. The aim of this pilot study was to explore clinical trial participants' use of consent discussions and information sheets when considering participating in clinical trials research. A qualitative, interview-based pilot study was designed in order to elicit, through dialogue, details of the reasons for participants' use of, and preferences regarding, different modes of information provision. Semi-structured interviews were undertaken with two different groups of patients who were participants in the Reinforcement of Closure of Stoma Site trial. The first group comprised newly-consented trial participants, who had been recruited up to 72 hours before our interview; the second group comprised patients attending a follow-up clinic 12 months after joining the trial. Thirteen participants were recruited in total: three newly-consented patients, and ten follow-up patients. The study found that participants' use of consent discussions to gain information about clinical trials was varied, and that they only minimally used information sheets after providing initial consent for the trial. Participants demonstrated varying degrees of knowledge about the trial, with some having forgotten that they were still involved in the trial. Participants reported a high level of trust in medical staff as a reason for not seeking more information about the trial. Some participants reported dissatisfaction with the timing of information provision. Some were amenable to novel ways of receiving trial information, such as web-based methods. The pilot study demonstrated the feasibility of a larger study into the provision of information to prospective clinical trial participants. The results suggest that considering alternative ways of providing information and the appropriateness of existing information provision may be acceptable to and useful for potential trial participants.
Collapse
Affiliation(s)
- Simon Paul Jenkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Melanie J. Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
- National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, West Midlands, United Kingdom
- National Institute for Health Research Applied Research Centre West Midlands, and National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, West Midlands, United Kingdom
| | - Heather Draper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, United Kingdom
| |
Collapse
|
22
|
Pruthi R, Robb ML, Oniscu GC, Tomson C, Bradley A, Forsythe JL, Metcalfe W, Bradley C, Dudley C, Johnson RJ, Watson C, Draper H, Fogarty D, Ravanan R, Roderick PJ. Inequity in Access to Transplantation in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:830-842. [PMID: 32467306 PMCID: PMC7274279 DOI: 10.2215/cjn.11460919] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. RESULTS Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%-33% for preemptive listing and 25%-40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). CONCLUSIONS Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.
Collapse
Affiliation(s)
- Rishi Pruthi
- Transplant, Renal and Urology Directorate, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom .,Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Matthew L Robb
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gabriel C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew Bradley
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, United Kingdom
| | | | - Rachel J Johnson
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Christopher Watson
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Heather Draper
- Department of Social Science and Systems in Health, University of Warwick, Coventry, United Kingdom
| | - Damian Fogarty
- Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
23
|
Hesseling PB, Bardin R, Brown JA, Kimbi C, Draper H, McCormick P, Kouya F. Wilms tumour: Long-term survival of patients treated at Mbingo Baptist Hospital in Cameroon between 2007 and 2012. South African Journal of Oncology 2019. [DOI: 10.4102/sajo.v3i0.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
24
|
Affiliation(s)
| | - Greg Moorlock
- Health Sciences, Warwick Medical School, Warwick, U.K
| | - Wendy Rogers
- Philosophy Department, Macquarie University, Sydney, Australia
| | - Jackie Leach Scully
- Disability Innovation Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
25
|
Abstract
This article sketches a taxonomy of the activities in which bioethics academics engage, including activities that may make their own research more impactful, from little or no engagement outside academia to activism or extreme activism. This taxonomy, the first of its kind, may be useful in determining what obligations bioethics academics have in relation to activism and activities that fall short of activism.
Collapse
Affiliation(s)
- Heather Draper
- Health Sciences, Warwick Medical School, Warwick, Warwickshire, UK
| |
Collapse
|
26
|
Behaegel J, Ní Dhubhghaill S, Draper H. Ethical issues in living-related corneal tissue transplantation. J Med Ethics 2019; 45:430-434. [PMID: 31123188 PMCID: PMC6691871 DOI: 10.1136/medethics-2018-105146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 05/13/2023]
Abstract
The cornea was the first human solid tissue to be transplanted successfully, and is now a common procedure in ophthalmic surgery. The grafts come from deceased donors. Corneal therapies are now being developed that rely on tissue from living-related donors. This presents new ethical challenges for ophthalmic surgeons, who have hitherto been somewhat insulated from debates in transplantation and donation ethics. This paper provides the first overview of the ethical considerations generated by ocular tissue donation from living donors and suggests how these might be addressed in practice. These are discussed in the context of a novel treatment for corneal limbal stem cell deficiency. This involves limbal cell grafts which are transplanted, either directly or after ex vivo expansion, onto recipient stem cell-deficient eyes. Where only one eye is diseased, the unaffected eye can be used as a source of graft tissue. Bilateral disease requires an allogenic donation, preferably from a genetically related living donor. While numerous papers have dealt with the theory, surgical approaches and clinical outcomes of limbal stem cell therapies, none has addressed the ethical dimensions of this form of tissue donation.
Collapse
Affiliation(s)
- Joséphine Behaegel
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Dept of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Wilrijk, Belgium
| | - Sorcha Ní Dhubhghaill
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Dept of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Wilrijk, Belgium
| | - Heather Draper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
27
|
Eisenstein N, Naumann D, Burns D, Stapley S, Draper H. Left Of Bang Interventions in Trauma: ethical implications for military medical prophylaxis. J Med Ethics 2018; 44:504-508. [PMID: 28814441 DOI: 10.1136/medethics-2017-104299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Advances in medical capability should be accompanied by discussion of their ethical implications. In the military medical context there is a growing interest in developing prophylactic interventions that will mitigate the effects of trauma and improve survival. The ethics of this novel capability are currently unexplored. This paper describes the concept of trauma prophylaxis (Left Of Bang Interventions in Trauma) and outlines some of the ethical issues that need to be considered, including within concept development, research and implementation. Trauma prophylaxis can be divided into interventions that do not (type 1) and those that do (type 2) have medical enhancement as an unintended side effect of their prophylactic action. We conclude that type 1 interventions have much in common with established military medical prophylaxis, and the potentially enhancing qualities of type 2 interventions raise different issues. We welcome further debate on both interventions.
Collapse
Affiliation(s)
- Neil Eisenstein
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - David Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - Daniel Burns
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - Sarah Stapley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
| | - Heather Draper
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
28
|
Moorlock G, Draper H. Empathy, social media, and directed altruistic living organ donation. Bioethics 2018; 32:289-297. [PMID: 29542172 PMCID: PMC6001484 DOI: 10.1111/bioe.12438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/08/2017] [Accepted: 11/27/2017] [Indexed: 06/13/2023]
Abstract
In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable 'statistical victims' into 'real people' with whom we can identify and feel empathy: the so-called 'identifiable victim effect', which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non-directed altruistic donation; (b) personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two.
Collapse
|
29
|
Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan AW, King MT, Hunn A, Bottomley A, Regnault A, Chan AW, Ells C, O'Connor D, Revicki D, Patrick D, Altman D, Basch E, Velikova G, Price G, Draper H, Blazeby J, Scott J, Coast J, Norquist J, Brown J, Haywood K, Johnson LL, Campbell L, Frank L, von Hildebrand M, Brundage M, Palmer M, Kluetz P, Stephens R, Golub RM, Mitchell S, Groves T. Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension. JAMA 2018; 319:483-494. [PMID: 29411037 DOI: 10.1001/jama.2017.21903] [Citation(s) in RCA: 452] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. Objective To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). Design, Setting, and Participants The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. Results The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n = 21) reduced this to 56 items, which were considered by 138 international stakeholder survey participants and 99 Delphi panelists. The final wording of the SPIRIT-PRO Extension was agreed on at a consensus meeting (n = 29 participants) and reviewed by external group of experts during a consultation period. Eleven extensions and 5 elaborations to the SPIRIT 2013 checklist were recommended for inclusion in clinical trial protocols in which PROs are a primary or key secondary outcome. Extension items focused on PRO-specific issues relating to the trial rationale, objectives, eligibility criteria, concepts used to evaluate the intervention, time points for assessment, PRO instrument selection and measurement properties, data collection plan, translation to other languages, proxy completion, strategies to minimize missing data, and whether PRO data will be monitored during the study to inform clinical care. Conclusions and Relevance The SPIRIT-PRO guidelines provide recommendations for items that should be addressed and included in clinical trial protocols in which PROs are a primary or key secondary outcome. Improved design of clinical trials including PROs could help ensure high-quality data that may inform patient-centered care.
Collapse
Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Rebecca Mercieca-Bebber
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine T King
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | - An-Wen Chan
- University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Ells
- Panel on Research Ethics, Toronto, Ontario, Canada
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, England
| | | | | | | | | | | | - Gary Price
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Jane Scott
- Janssen Global Services, Johnson and Johnson, High Wycombe, England
| | | | | | | | | | | | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, England
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC
| | - Maria von Hildebrand
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Paul Kluetz
- US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Stephens
- National Cancer Research Institute Consumer Forum, London, England
| | | | | | | |
Collapse
|
30
|
Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, Roderick P, Johnson RJ, Ravanan R, Fogarty D, Bradley C, Gibbons A, Metcalfe W, Draper H, Bradley AJ, Oniscu GC. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant 2018; 32:890-900. [PMID: 28379431 PMCID: PMC5427518 DOI: 10.1093/ndt/gfx036] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/09/2017] [Indexed: 02/06/2023] Open
Abstract
Background. Living donor kidney transplantation (LDKT) provides more timely access to transplantation and better clinical outcomes than deceased donor kidney transplantation (DDKT). This study investigated disparities in the utilization of LDKT in the UK. Methods. A total of 2055 adults undergoing kidney transplantation between November 2011 and March 2013 were prospectively recruited from all 23 UK transplant centres as part of the Access to Transplantation and Transplant Outcome Measures (ATTOM) study. Recipient variables independently associated with receipt of LDKT versus DDKT were identified. Results. Of the 2055 patients, 807 (39.3%) received LDKT and 1248 (60.7%) received DDKT. Multivariable modelling demonstrated a significant reduction in the likelihood of LDKT for older age {odds ratio [OR] 0.11 [95% confidence interval (CI) 0.08–0.17], P < 0.0001 for 65–75 years versus 18–34 years}; Asian ethnicity [OR 0.55 (95% CI 0.39–0.77), P = 0.0006 versus White]; Black ethnicity [OR 0.64 (95% CI 0.42–0.99), P = 0.047 versus White]; divorced, separated or widowed [OR 0.63 (95% CI 0.46–0.88), P = 0.030 versus married]; no qualifications [OR 0.55 (95% CI 0.42–0.74), P < 0.0001 versus higher education qualifications]; no car ownership [OR 0.51 (95% CI 0.37–0.72), P = 0.0001] and no home ownership [OR 0.65 (95% CI 0.85–0.79), P = 0.002]. The odds of LDKT varied significantly between countries in the UK. Conclusions. Among patients undergoing kidney transplantation in the UK, there are significant age, ethnic, socio-economic and geographic disparities in the utilization of LDKT. Further work is needed to explore the potential for targeted interventions to improve equity in living donor transplantation.
Collapse
Affiliation(s)
- Diana A Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - John L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.,NHS Blood and Transplant, Bristol, UK
| | | | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Rommel Ravanan
- Department of Renal Medicine, Southmead Hospital, Bristol, UK
| | - Damian Fogarty
- Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Heather Draper
- Health Sciences, University of Warwick, Conventry, UK (author has moved institutions since acceptance of the article)
| | - Andrew J Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | |
Collapse
|
31
|
Abstract
Case studies used in psychiatry for teaching and learning can include large amounts of personal information, and most medical journals refuse to publish case material without patient consent. However, not all patients are capable of consenting and maintaining anonymity is not always successful. Disclosure of personal information without consent can cause a sense of violation, but a principle of non-violation rigorously applied would prohibit the use of such material without consent, even if the patient is completely unidentifiable. A public interest argument can be made for using patient information for teaching purposes. Furthermore, a limited case can be made for using, and even publishing, some cases without consent, e.g. those requiring urgent public discussion or concerning people who are incapable of giving consent. Thus, an argument can be put forward for relaxing to this limited degree the demand for patient consent to publish case material.
Collapse
|
32
|
Jenkins S, Ives J, Avery S, Draper H. Who gets the gametes? An argument for a points system for fertility patients. Bioethics 2018; 32:16-26. [PMID: 29194680 PMCID: PMC5767753 DOI: 10.1111/bioe.12411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/28/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
This paper argues that the convention of allocating donated gametes on a 'first come, first served' basis should be replaced with an allocation system that takes into account more morally relevant criteria than waiting time. This conclusion was developed using an empirical bioethics methodology, which involved a study of the views of 18 staff members from seven U.K. fertility clinics, and 20 academics, policy-makers, representatives of patient groups, and other relevant professionals, on the allocation of donated sperm and eggs. Against these views, we consider some nuanced ways of including criteria in a points allocation system. We argue that such a system is more ethically robust than 'first come, first served', but we acknowledge that our results suggest that a points system will meet with resistance from those working in the field. We conclude that criteria such as a patient's age, potentially damaging substance use, and parental status should be used to allocate points and determine which patients receive treatment and in what order. These and other factors should be applied according to how they bear on considerations like child welfare, patient welfare, and the effectiveness of the proposed treatment.
Collapse
|
33
|
Draper H, Jenkins S. Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014-2015 Ebola outbreak: a qualitative study. BMC Med Ethics 2017; 18:77. [PMID: 29258519 PMCID: PMC5738057 DOI: 10.1186/s12910-017-0234-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background As part of its response to the 2014 Ebola outbreak in west Africa, the United Kingdom (UK) government established an Ebola treatment unit in Sierra Leone, staffed by military personnel. Little is known about the ethical challenges experienced by military medical staff on humanitarian deployment. We designed a qualitative study to explore this further with those who worked in the treatment unit. Method Semi-structured, face-to-face and telephone interviews were conducted with 20 UK military personnel deployed between October 2014 and April 2015 in one of three roles in the Ebola treatment unit: clinician; nursing and nursing assistant; and other medical support work, including infection control and laboratory and mortuary services. Results Many participants reported feeling ethically motivated to volunteer for deployment, but for some personal interests were also a consideration. A small minority had negative feelings towards the deployment, others felt that this deployment like any other was part of military service. Almost all had initial concerns about personal safety but were reassured by their pre-deployment 'drills and skills', and personal protective equipment. Risk perceptions were related to perceptions about military service. Efforts to minimise infection risk were perceived to have made good patient care more difficult. Significantly, some thought the humanitarian nature of the mission justified tolerating greater risks to staff. Trust in the military institution and colleagues was expressed; many participants referred to the ethical obligation within the chain of command to protect those under their command. Participants expected resources to be overwhelmed and ‘empty beds’ presented a significant and pervasive ethical challenge. Most thought more patients could and should have been treated. Points of reference for participants’ ethical values were: previous deployment experience; previous UK/National Health Service experience; professional ethics; and, distinctly military values (that might not be shared with non-military workers). Conclusion We report the first systematic exploration of the ethical challenges face by a Western medical military in the international response to the first major Ebola outbreak. We offer unique insights into the military healthcare workers’ experiences of humanitarian deployment. Many participants expressed motivations that gave them common purpose with civilian volunteers.
Collapse
Affiliation(s)
- Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.
| | - Simon Jenkins
- Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| |
Collapse
|
34
|
Taylor DM, Bradley JA, Bradley C, Draper H, Johnson R, Metcalfe W, Oniscu G, Robb M, Tomson C, Watson C, Ravanan R, Roderick P. Limited health literacy in advanced kidney disease. Kidney Int 2017; 90:685-95. [PMID: 27521115 DOI: 10.1016/j.kint.2016.05.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/23/2016] [Accepted: 05/26/2016] [Indexed: 12/21/2022]
Abstract
Limited health literacy may reduce the ability of patients with advanced kidney disease to understand their disease and treatment and take part in shared decision making. In dialysis and transplant patients, limited health literacy has been associated with low socioeconomic status, comorbidity, and mortality. Here, we investigated the prevalence and associations of limited health literacy using data from the United Kingdom-wide Access to Transplantation and Transplant Outcome Measures (ATTOM) program. Incident dialysis, incident transplant, and transplant wait-listed patients ages 18 to 75 were recruited from 2011 to 2013 and data were collected from patient questionnaires and case notes. A score >2 in the Single-Item Literacy Screener was used to define limited health literacy. Univariate and multivariate analyses were performed to identify patient factors associated with limited health literacy. We studied 6842 patients, 2621 were incident dialysis, 1959 were wait-listed, and 2262 were incident transplant. Limited health literacy prevalence was 20%, 15%, and 12% in each group, respectively. Limited health literacy was independently associated with low socioeconomic status, poor English fluency, and comorbidity. However, transplant wait-listing, preemptive transplantation, and live-donor transplantation were associated with increasing health literacy.
Collapse
Affiliation(s)
- Dominic M Taylor
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK; Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK.
| | - John A Bradley
- Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Matthew Robb
- National Health Service Blood and Transplant, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, UK
| | - Chris Watson
- Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Rommel Ravanan
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK
| | - Paul Roderick
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
35
|
Gare R, Gogalniceanu P, Maple H, Burnapp L, Clarke A, Williams L, Norton S, Chilcot J, Gibbs P, Mitchell A, McCrone P, Draper H, Mamode N. Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional's and patient's perspectives: research protocol for a national multicentre mixed-methods prospective cohort study. BMJ Open 2017; 7:e015971. [PMID: 28939572 PMCID: PMC5623565 DOI: 10.1136/bmjopen-2017-015971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Living donation accounts for over one-third of all kidney transplants taking place in the UK. 1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group. AIMS The research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation. METHODS The research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate). DISSEMINATION The findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation. TRIAL REGISTRATION NUMBER ISRCTN23895878, Pre-results.
Collapse
Affiliation(s)
- Rebecca Gare
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Petrut Gogalniceanu
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Hannah Maple
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Lisa Burnapp
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
- NHS Blood and Transplant, London, UK
| | | | | | - Sam Norton
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Gibbs
- Renal Transplant Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Paul McCrone
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nizam Mamode
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| |
Collapse
|
36
|
Taylor DM, Fraser SD, Bradley JA, Bradley C, Draper H, Metcalfe W, Oniscu GC, Tomson CR, Ravanan R, Roderick PJ. A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD. Clin J Am Soc Nephrol 2017; 12:1070-1084. [PMID: 28487346 PMCID: PMC5498363 DOI: 10.2215/cjn.12921216] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The self-management and decision-making skills required to manage CKD successfully may be diminished in those with low health literacy. A 2012 review identified five papers reporting the prevalence of limited health literacy in CKD, largely from United States dialysis populations. The literature has expanded considerably since. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used systematic review, pooled prevalence analysis, metaregression, and exploration of heterogeneity in studies of patients with CKD (all stages). RESULTS From 433 studies, 15 new studies met the inclusion criteria and were analyzed together with five studies from the 2012 review. These included 13 cross-sectional surveys, five cohort studies (using baseline data), and two using baseline clinical trial data. Most (19 of 20) were from the United States. In total, 12,324 patients were studied (3529 nondialysis CKD, 5289 dialysis, 2560 transplant, and 946 with unspecified CKD; median =198.5; IQR, 128.5-260 per study). Median prevalence of limited health literacy within studies was 23% (IQR, 16%-33%), and pooled prevalence was 25% (95% confidence interval, 20% to 30%) with significant between-study heterogeneity (I2=97%). Pooled prevalence of limited health literacy was 25% (95% confidence interval, 16% to 33%; I2=97%) among patients with CKD not on dialysis, 27% (95% confidence interval, 19% to 35%; I2=96%) among patients on dialysis, and 14% (95% confidence interval, 7% to 21%; I2=97%) among patients with transplants. A higher proportion of nonwhite participants was associated with increased limited health literacy prevalence (P=0.04), but participant age was not (P=0.40). Within studies, nonwhite ethnicity and low socioeconomic status were consistently and independently associated with limited health literacy. Studies were of low or moderate quality. Within-study participant selection criteria had potential to introduce bias. CONCLUSIONS Limited health literacy is common in CKD, especially among individuals with low socioeconomic status and nonwhite ethnicity. This has implications for the design of self-management and decision-making initiatives to promote equity of care and improve quality. Lower prevalence among patients with transplants may reflect selection of patients with higher health literacy for transplantation either because of less comorbidity in this group or as a direct effect of health literacy on access to transplantation.
Collapse
Affiliation(s)
- Dominic M. Taylor
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Simon D.S. Fraser
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - J. Andrew Bradley
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Gabriel C. Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; and
| | - Charles R.V. Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, United Kingdom
| | - Rommel Ravanan
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Paul J. Roderick
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
37
|
Li B, Cairns JA, Draper H, Dudley C, Forsythe JL, Johnson RJ, Metcalfe W, Oniscu GC, Ravanan R, Robb ML, Roderick P, Tomson CR, Watson CJE, Bradley JA. Estimating Health-State Utility Values in Kidney Transplant Recipients and Waiting-List Patients Using the EQ-5D-5L. Value Health 2017; 20:976-984. [PMID: 28712628 PMCID: PMC5541449 DOI: 10.1016/j.jval.2017.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 11/22/2016] [Accepted: 01/27/2017] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To report health-state utility values measured using the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) in a large sample of patients with end-stage renal disease and to explore how these values vary in relation to patient characteristics and treatment factors. METHODS As part of the prospective observational study entitled "Access to Transplantation and Transplant Outcome Measures," we captured information on patient characteristics and treatment factors in a cohort of incident kidney transplant recipients and a cohort of prevalent patients on the transplant waiting list in the United Kingdom. We assessed patients' health status using the EQ-5D-5L and conducted multivariable regression analyses of index scores. RESULTS EQ-5D-5L responses were available for 512 transplant recipients and 1704 waiting-list patients. Mean index scores were higher in transplant recipients at 6 months after transplant surgery (0.83) compared with patients on the waiting list (0.77). In combined regression analyses, a primary renal diagnosis of diabetes was associated with the largest decrement in utility scores. When separate regression models were fitted to each cohort, female gender and Asian ethnicity were associated with lower utility scores among waiting-list patients but not among transplant recipients. Among waiting-list patients, longer time spent on dialysis was also associated with poorer utility scores. When comorbidities were included, the presence of mental illness resulted in a utility decrement of 0.12 in both cohorts. CONCLUSIONS This study provides new insights into variations in health-state utility values from a single source that can be used to inform cost-effectiveness evaluations in patients with end-stage renal disease.
Collapse
Affiliation(s)
- Bernadette Li
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - John A Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Heather Draper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | | | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charles R Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| |
Collapse
|
38
|
Gibbons A, Cinnirella M, Bayfield J, Wu D, Draper H, Johnson RJ, Tomson CRV, Forsythe JLR, Metcalfe W, Fogarty D, Roderick P, Ravanan R, Oniscu GC, Watson CJE, Bradley JA, Bradley C. Patient preferences, knowledge and beliefs about kidney allocation: qualitative findings from the UK-wide ATTOM programme. BMJ Open 2017; 7:e013896. [PMID: 28132010 PMCID: PMC5278279 DOI: 10.1136/bmjopen-2016-013896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To explore how patients who are wait-listed for or who have received a kidney transplant understand the current UK kidney allocation system, and their views on ways to allocate kidneys in the future. DESIGN Qualitative study using semistructured interviews and thematic analysis based on a pragmatic approach. PARTICIPANTS 10 deceased-donor kidney transplant recipients, 10 live-donor kidney transplant recipients, 12 participants currently wait-listed for a kidney transplant and 4 participants whose kidney transplant failed. SETTING Semistructured telephone interviews conducted with participants in their own homes across the UK. RESULTS Three main themes were identified: uncertainty of knowledge of the allocation scheme; evaluation of the system and participant suggestions for future allocation schemes. Most participants identified human leucocyte anitgen matching as a factor in determining kidney allocation, but were often uncertain of the accuracy of their knowledge. In the absence of information that would allow a full assessment, the majority of participants consider that the current system is effective. A minority of participants were concerned about the perceived lack of transparency of the general decision-making processes within the scheme. Most participants felt that people who are younger and those better matched to the donor kidney should be prioritised for kidney allocation, but in contrast to the current scheme, less priority was considered appropriate for longer waiting patients. Some non-medical themes were also discussed, such as whether parents of dependent children should be prioritised for allocation, and whether patients with substance abuse problems be deprioritised. CONCLUSIONS Our participants held differing views about the most important factors for kidney allocation, some of which were in contrast to the current scheme. Patient participation in reviewing future allocation policies will provide insight as to what is considered acceptable to patients and inform healthcare staff of the kinds of information patients would find most useful.
Collapse
Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
| | - Marco Cinnirella
- Department ofPsychology, Royal Holloway University of London, Egham, UK
| | - Janet Bayfield
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
| | - Diana Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Heather Draper
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Rachel J Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | | | - John L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Damian Fogarty
- Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Paul Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rommel Ravanan
- Department of Renal Medicine, Southmead Hospital, Bristol, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge, the NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge, the NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
- Health Psychology Research Ltd, Royal Holloway University of London, Egham, UK
| |
Collapse
|
39
|
Richardson T, Johnston AM, Draper H. A Systematic Review of Ebola Treatment Trials to Assess the Extent to Which They Adhere to Ethical Guidelines. PLoS One 2017; 12:e0168975. [PMID: 28095476 PMCID: PMC5240928 DOI: 10.1371/journal.pone.0168975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/11/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Objective: To determine to what extent each trial met criteria specified in three research frameworks for ethical trial conduct. Design: Systematic review and narrative analysis. METHODS AND FINDINGS Data sources: MEDBASE and EMBASE databases were searched using a specific search strategy. The Cochrane database for systematic reviews, the PROSPERO database and trial registries were examined. A grey literature search and citation search were also carried out. Eligibility criteria for selecting studies: Studies were included where the intervention was being used to treat Ebola in human subjects regardless of study design, comparator or outcome measured. Studies were eligible if they had taken place after the 21st March 2014. Unpublished as well as published studies were included. Included studies: Sixteen studies were included in the data synthesis. Data was extracted on study characteristics as well as any information relating to ten ethical areas of interest specified in the three research frameworks for ethical trial conduct and an additional criterion of whether the study received ethics approval from a research ethics committee. Synthesis of results: Eight studies were judged to fully comply with all eleven criteria. The other eight studies all had at least one criteria where there was not enough information available to draw any conclusions. In two studies there were ethical concerns regarding the information provided in relation to at least one ethical criteria. Description of the effect: One study did not receive ethical approval as the authors argued that treating approximately one hundred patients consecutively for compassionate reasons did not constitute a clinical trial. Furthermore, after the patients were treated, physicians in Sierra Leone did not release reports of treatment results and so study conclusions had to be made based on unpublished observations. In another study the risk-benefit ratio of the trial drug does not appear to be favourable and the pre-trial evidence base for its effectiveness against Ebola is speculative. CONCLUSIONS Some limited and appropriate deviation from standard research expectations in disaster situations is increasingly accepted. However, this is not an excuse for poor ethics oversight and international regulations are in place which should not be ignored. New guidelines are needed that better define the boundaries between using medicines for compassionate use and conducting a clinical trial. Greater support should be offered for local research ethics committees in affected areas so that they can provide robust ethical review. Further systematic reviews should be carried out in epidemics of any novel infectious diseases to assess if comparable findings arise.
Collapse
Affiliation(s)
- Thomas Richardson
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew McDonald Johnston
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Heather Draper
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
40
|
Meyer R, Dumkow L, Draper H, Brandt K, Deyoung GR, Weise A, Egwuatu N. Impact of Pharmacist-Led Antimicrobial Stewardship on the Treatment of Urinary Tract Infections and Pyelonephritis in the Emergency Department. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rachel Meyer
- Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Lisa Dumkow
- Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Heather Draper
- Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Kasey Brandt
- Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - G. Robert Deyoung
- Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Andrew Weise
- Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Nnaemeka Egwuatu
- Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, Michigan
| |
Collapse
|
41
|
Sikkenga T, Dumkow L, Draper H, Brandt K, Rivard K, Axford K, Whalen D, Egwuatu N. Implementation of a Nursing Triage Order to Improve Utilization of Rapid Diagnostic Testing for Chlamydia and Gonorrhea in the Emergency Department. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Taylor Sikkenga
- College of Pharmacy, Ferris State University, Big Rapids, Michigan
| | - Lisa Dumkow
- Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Heather Draper
- Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Kasey Brandt
- Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | | | - Katie Axford
- College of Pharmacy, Ferris State University, Big Rapids, Michigan
| | - David Whalen
- Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, Michigan
| | - Nnaemeka Egwuatu
- Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, Michigan
| |
Collapse
|
42
|
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) collected in clinical trials should be administered in a standardised way across sites and routinely screened for avoidable missing data in order to maximise data quality/minimise risk of bias. Recent qualitative findings, however, have raised concerns about the consistency of PROM administration in UK trials. The purpose of this study was to determine the generalisability of these findings across the wider community of trial personnel. DESIGN Online cross-sectional survey. SETTING Participants were recruited from 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. PARTICIPANTS Research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials collecting PROMs. ANALYSIS We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. Factors associated with the management of missing PRO data were explored using logistic regression. RESULTS Survey data from 767 respondents supported the generalisability of qualitative study findings, suggesting inconsistencies in PROM administration with regard to: the level of assistance given to trial participants; the timing of PROM completion in relation to the clinical consultation; and the management of missing data. Having ≥10 years experience in a research role was significantly associated with the appropriate management of missing PROM data (OR 2.26 (95% CI 1.06 to 4.82), p=0.035). There was a consensus that more PROM guidance was needed in future trials and agreement between professional groups about the necessary components. CONCLUSIONS There are inconsistencies in the way PROMs are administered by trial staff. Such inconsistencies may reduce the quality of data and have the potential to introduce bias. There is a need for improved guidance in future trials that support trial personnel in conducting optimal PROM data collection to inform patient care.
Collapse
Affiliation(s)
- Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Ives
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
43
|
Moorlock G, Ives J, Bramhall S, Draper H. Should We Reject Donated Organs on Moral Grounds or Permit Allocation Using Non-Medical Criteria?: A Qualitative Study. Bioethics 2016; 30:282-92. [PMID: 26132802 PMCID: PMC4975598 DOI: 10.1111/bioe.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Conditional and directed deceased organ donations occur when donors (or often their next of kin) attempt to influence the allocation of their donated organs. This can include asking that the organs are given to or withheld from certain types of people, or that they are given to specified individuals. Donations of these types have raised ethical concerns, and have been prohibited in many countries, including the UK. In this article we report the findings from a qualitative study involving interviews with potential donors (n = 20), potential recipients (n = 9) and transplant staff (n = 11), and use these results as a springboard for further ethical commentary. We argue that although participants favoured unconditional donation, this preference was grounded in a false distinction between 'medical' and 'non-medical' allocation criteria. Although there are good reasons to maintain organ allocation based primarily upon the existing 'medical' criteria, it may be premature to reject all other potential criteria as being unacceptable. Part of participants' justification for allocating organs using 'medical' criteria was to make the best use of available organs and avoid wasting their potential benefit, but this can also justify accepting conditional donations in some circumstances. We draw a distinction between two types of waste - absolute and relative - and argue that accepting conditional donations may offer a balance between these forms of waste.
Collapse
|
44
|
Charles A, Rid A, Davies H, Draper H. Prisoners as research participants: current practice and attitudes in the UK. J Med Ethics 2016; 42:246-252. [PMID: 24958334 DOI: 10.1136/medethics-2012-101059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/01/2014] [Indexed: 06/03/2023]
Abstract
The use of prisoners as research participants is controversial. Efforts to protect them in response to past exploitation and abuse have led to strict regulations and reluctance to involve them as participants. Hence, prisoners are routinely denied the opportunity to participate in research. In the absence of comprehensive information regarding prisoners' current involvement in research, we examined UK prisoners' involvement through review of research applications to the UK National Research Ethics Service. We found that prisoners have extremely limited access to research participation. This analysis was augmented by a survey of those involved in research and research governance (UK researchers and Research Ethics Committee members). Our results suggest that pragmatic concerns regarding the perceived burden of including prisoners are far more prominent in motivating their exclusion than ethical concerns or knowledge of regulations. While prisoners may remain a vulnerable research population due to constraints upon their liberty and autonomy and the coercive nature of the prison environment, routine exclusion from participation may be disadvantageous. Rigorous ethical oversight and the shift in the prevailing attitude towards the risks and benefits of participation suggest that it may be time for research to be more accessible to prisoners in line with the principle of equivalence in prison healthcare. We suggest the necessary first step in this process is a re-examination of current guidance in the UK and other countries with exclusions.
Collapse
Affiliation(s)
- Anna Charles
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Annette Rid
- Institute of Biomedical Ethics, University of Zürich, Zürich, Switzerland Department of Social Science, Health and Medicine, King's College London, London, UK
| | - Hugh Davies
- National Research Ethics Service, London, UK
| | - Heather Draper
- Medicine, Ethics, Society and History (MESH), School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
45
|
Oniscu GC, Ravanan R, Wu D, Gibbons A, Li B, Tomson C, Forsythe JL, Bradley C, Cairns J, Dudley C, Watson CJE, Bolton EM, Draper H, Robb M, Bradbury L, Pruthi R, Metcalfe W, Fogarty D, Roderick P, Bradley JA. Access to Transplantation and Transplant Outcome Measures (ATTOM): study protocol of a UK wide, in-depth, prospective cohort analysis. BMJ Open 2016; 6:e010377. [PMID: 26916695 PMCID: PMC4769394 DOI: 10.1136/bmjopen-2015-010377] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is significant intercentre variability in access to renal transplantation in the UK due to poorly understood factors. The overarching aims of this study are to improve equity of access to kidney and kidney-pancreas transplantation across the UK and to optimise organ allocation to maximise the benefit and cost-effectiveness of transplantation. METHODS AND ANALYSIS 6844 patients aged 18-75 years starting dialysis and/or receiving a transplant together with matched patients active on the transplant list from all 72 UK renal units were recruited between November 2011 and March 2013 and will be followed for at least 3 years. The outcomes of interest include patient survival, access to the transplant list, receipt of a transplant, patient-reported outcome measures (PROMs) including quality of life, treatment satisfaction, well-being and health status on different forms of renal replacement therapy. Sociodemographic and clinical data were prospectively collected from case notes and from interviews with patients and local clinical teams. Qualitative process exploration with clinical staff will help identify unit-specific factors that influence access to renal transplantation. A health economic analysis will explore costs and outcomes associated with alternative approaches to organ allocation. The study will deliver: (1) an understanding of patient and unit-specific factors influencing access to renal transplantation in the UK, informing potential changes to practices and policies to optimise outcomes and reduce intercentre variability; (2) a patient-survival probability model to standardise access to the renal transplant list and (3) an understanding of PROMs and health economic impact of kidney and kidney-pancreas transplantation to inform the development of a more sophisticated and fairer organ allocation algorithm. ETHICS AND DISSEMINATION The protocol has been independently peer reviewed by National Institute for Health Research (NIHR) and approved by the East of England Research Ethics Committee. The results will be published in peer-reviewed journals and presented at conferences.
Collapse
Affiliation(s)
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | - Diana Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - Bernadette Li
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Eleanor M Bolton
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Heather Draper
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| |
Collapse
|
46
|
Kyte D, Ives J, Draper H, Calvert M. Management of Patient-Reported Outcome (PRO) Alerts in Clinical Trials: A Cross Sectional Survey. PLoS One 2016; 11:e0144658. [PMID: 26785084 PMCID: PMC4718453 DOI: 10.1371/journal.pone.0144658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022] Open
Abstract
Background Assessment of patient-reported outcomes (PROs) provides valuable information to inform patient-centered care, but may also reveal ‘PRO alerts’: psychological distress or physical symptoms that may require an immediate response. Ad-hoc management of PRO alerts in clinical trials may result in suboptimal patient care or potentially bias trial results. To gain greater understanding of current practice in PRO alert management we conducted a national survey of personnel involved in clinical trials with a PRO endpoint. Methods and Findings We conducted a national cross-sectional survey of 767 UK-based research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials using PROs. Respondents were self-selected volunteers from a non-randomised sample of eligible individuals recruited via 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. Questions centred on the proportion of trial personnel encountering alerts, how staff responded to PRO alerts and whether current guidance was deemed sufficient to support research personnel. We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. 20% of research nurses did not view completed PRO questionnaires and were not in a position to discover alerts, 39–50% of the remaining respondent group participants reported encountering PRO alerts. Of these, 83% of research nurses and 54% of data managers/trial coordinators reported taking action to assist the trial participant, but less than half were able to record the intervention in the trial documentation. Research personnel reported current PRO alert guidance/training was insufficient. Conclusions Research personnel are intermittently exposed to PRO alerts. Some intervene to help trial participants, but are not able to record this intervention in the trial documentation, risking co-intervention bias. Other staff do not check PRO information during the trial, meaning alerts may remain undiscovered, or do not respond to alerts if they are inadvertently encountered; both of which may impact on patient safety. Guidance is needed to support PRO alert management that protects the interests of trial participants whilst avoiding potential bias.
Collapse
Affiliation(s)
- Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Ives
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| |
Collapse
|
47
|
Rivard K, Bucher K, Draper H, Deyoung GR, Egwuatu N, Whalen D, Dumkow L. Impact of Point of Care Screening for Chlamydia and Gonorrhea on Antimicrobial Stewardship in the Emergency Department. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
48
|
Moorlock G, Neuberger J, Draper H. Split liver transplantation: Papering over the cracks of the organ shortage. Clinical Ethics 2015; 10:83-89. [DOI: 10.1177/1477750915599703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Splitting livers allows two people (usually an adult and a child) to receive a liver transplant from one donated adult liver, but the risks to the adult recipient are greater than if they had received the equivalent whole liver. It has been suggested, therefore, that splitting livers harms adult recipients. Without liver splitting, however, there would be few livers available for children, and paediatric waiting time and waiting list mortality would significantly increase. In this paper, we argue that although splitting livers makes adults worse off, this should be considered sub-optimal benefit rather than harm. We explore justifications for sub-optimally benefitting adults in this way and consider alternatives to the current approach. We argue that splitting livers masks the more fundamental problem of low paediatric donation rates and that increasing the number of paediatric donations would improve the situation for both adult and paediatric liver patients.
Collapse
Affiliation(s)
- Greg Moorlock
- Institute of Applied Health Research, University of Birmingham, UK
| | | | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, UK
| |
Collapse
|
49
|
Li B, Cairns JA, Fotheringham J, Tomson CR, Forsythe JL, Watson C, Metcalfe W, Fogarty DG, Draper H, Oniscu GC, Dudley C, Johnson RJ, Roderick P, Leydon G, Bradley JA, Ravanan R. Understanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffs. Nephrol Dial Transplant 2015; 30:1726-34. [PMID: 26071229 DOI: 10.1093/ndt/gfv224] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a number of countries, reimbursement to hospitals providing renal dialysis services is set according to a fixed tariff. While the cost of maintenance dialysis and transplant surgery are amenable to a system of fixed tariffs, patients with established renal failure commonly present with comorbid conditions that can lead to variations in the need for hospitalization beyond the provision of renal replacement therapy. METHODS Patient-level cost data for incident renal replacement therapy patients in England were obtained as a result of linkage of the Hospital Episodes Statistics dataset to UK Renal Registry data. Regression models were developed to explore variations in hospital costs in relation to treatment modality, number of years on treatment and factors such as age and comorbidities. The final models were then used to predict annual costs for patients with different sets of characteristics. RESULTS Excluding the cost of renal replacement therapy itself, inpatient costs generally decreased with number of years on treatment for haemodialysis and transplant patients, whereas costs for patients receiving peritoneal dialysis remained constant. Diabetes was associated with higher mean annual costs for all patients irrespective of treatment modality and hospital setting. Age did not have a consistent effect on costs. CONCLUSIONS Combining predicted hospital costs with the fixed costs of renal replacement therapy showed that the total cost differential for a patient continuing on dialysis rather than receiving a transplant is considerable following the first year of renal replacement therapy, thus reinforcing the longer-term economic advantage of transplantation over dialysis for the health service.
Collapse
Affiliation(s)
- Bernadette Li
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - John A Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | - Damian G Fogarty
- Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Heather Draper
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| |
Collapse
|
50
|
Abstract
This paper explores whether donor-parents felt coerced to donate a kidney to their child. There is a paucity of UK literature on parental live kidney donors and the voluntariness of their decision-making. Data were gathered as part of a study exploring parental experiences of consenting for live donation at a UK specialist children's hospital. Parents who donated a kidney to their child between September 2006 and December 2010 and who consented at their child's hospital to be referred to an adult unit for consideration for live donation were invited to participate. Of the 19 eligible parents, seven fathers and three mothers consented to be interviewed. Their primary motivation for donation was being a parent (more specifically, the parent of a sick child). Participants expressed this in terms of parental love and concern. Participants conveyed certainty about their decision and viewed live donation as a positive opportunity. Most participants regarded the decision to donate, or not donate, as one every parent is entitled to make for their own reasons. In discussing our findings, we argue that when parents do not separate their child's interests from their own, this does not necessarily compromise autonomous decision-making: using one's own moral values to constrain one's own choices can be compatible with voluntary decision-making. Indeed, choices may be more constrained when parents are unable to donate, because this reduces the options available to parents to help their child.
Collapse
Affiliation(s)
- Philippa Burnell
- Department of Acute Internal Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sally-Anne Hulton
- Department of Paediatric Nephrology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Heather Draper
- School of Health and Population Science, University of Birmingham, Birmingham, UK
| |
Collapse
|