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Elvevi A, Laffusa A, Elisei F, Morzenti S, Guerra L, Rovere A, Invernizzi P, Massironi S. Any role for transarterial radioembolization in unresectable intrahepatic cholangiocarcinoma in the era of advanced systemic therapies? World J Hepatol 2023; 15:1284-1293. [PMID: 38223418 PMCID: PMC10784807 DOI: 10.4254/wjh.v15.i12.1284] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is recognized as the second most frequently diagnosed liver malignancy, following closely after hepatocellular carcinoma. Its incidence has seen a global upsurge in the past several years. Unfortunately, due to the lack of well-defined risk factors and limited diagnostic tools, iCCA is often diagnosed at an advanced stage, resulting in a poor prognosis. While surgery is the only potentially curative option, it is rarely feasible. Currently, there are ongoing investigations into various treatment approaches for unresectable iCCA, including conventional chemotherapies, targeted therapies, immunotherapies, and locoregional treatments. This study aims to explore the role of transarterial radioembolization (TARE) in the treatment of unresectable iCCA and provide a comprehensive review. The findings suggest that TARE is a safe and effective treatment option for unresectable iCCA, with a median overall survival (OS) of 14.9 months in the study cohort. Studies on TARE for unresectable iCCA, both as a first-line treatment (as a neo-adjuvant down-staging strategy) and as adjuvant therapy, have reported varying median response rates (ranging from 34% to 86%) and median OS (12-16 mo). These differences can be attributed to the heterogeneity of the patient population and the limited number of participants in the studies. Most studies have identified tumor burden, portal vein involvement, and the patient's performance status as key prognostic factors. Furthermore, a phase 2 trial evaluated the combination of TARE and chemotherapy (cisplatin-gemcitabine) as a first-line therapy for locally advanced unresectable iCCA. The results showed promising outcomes, including a median OS of 22 mo and a 22% achievement in down-staging the tumor. In conclusion, TARE represents a viable treatment option for unresectable iCCA, and its combination with systemic chemotherapy has shown promising results. However, it is important to consider treatment-independent factors that can influence prognosis. Further research is necessary to identify optimal treatment combinations and predictive factors for a favorable response in iCCA patients.
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Affiliation(s)
- Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Alice Laffusa
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Federica Elisei
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori University of Milano Bicocca, Monza 20900, Italy
| | - Sabrina Morzenti
- Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Luca Guerra
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori University of Milano Bicocca, Monza 20900, Italy
| | - Antonio Rovere
- Department of Radiology and Interventional Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza 20900, Italy.
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Kolaja CA, Belding JN, Boparai SK, Castañeda SF, Geronimo-Hara TR, Powell TM, Tu XM, Walstrom JL, Sheppard BD, Rull RP. Survey response over 15 years of follow-up in the Millennium Cohort Study. BMC Med Res Methodol 2023; 23:205. [PMID: 37689640 PMCID: PMC10492282 DOI: 10.1186/s12874-023-02018-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/09/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Patterns of survey response and the characteristics associated with response over time in longitudinal studies are important to discern for the development of tailored retention efforts aimed at minimizing response bias. The Millennium Cohort Study, the largest and longest running cohort study of military personnel and veterans, is designed to examine the long-term health effects of military service and experiences and thus relies on continued participant survey responses over time. Here, we describe the response rates for follow-up survey data collected over 15 years and identify characteristics associated with follow-up survey response and mode of response (paper vs. web). METHOD Patterns of follow-up survey response and response mode (web, paper, none) were examined among eligible participants (n=198,833), who were initially recruited in four panels from 2001 to 2013 in the Millennium Cohort Study, for a follow-up period of 3-15 years (2004-2016). Military and sociodemographic factors (i.e., enrollment panel, sex, birth year, race and ethnicity, educational attainment, marital status, service component, service branch, pay grade, military occupation, length of service, and time deployed), life experiences and health-related factors (i.e., military deployment/combat experience, life stressors, mental health, physical health, and unhealthy behaviors) were used to examine follow-up response and survey mode over time in multivariable generalized estimating equation models. RESULTS Overall, an average response rate of 60% was observed across all follow-up waves. Factors associated with follow-up survey response over time included increased educational attainment, married status, female sex, older age, military deployment (regardless of combat experience), and higher number of life stressors, mental health issues, and physical health diagnoses. CONCLUSION Despite the challenges associated with collecting multiple waves of follow-up survey data from members of the U.S. military during and after service, the Millennium Cohort Study has maintained a relatively robust response rate over time. The incorporation of tailored messages and outreach to those groups least likely to respond over time may improve retention and thereby increase the representativeness and generalizability of collected survey data.
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Affiliation(s)
- Claire A Kolaja
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
- Leidos, Inc, San Diego, CA, USA.
| | - Jennifer N Belding
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Satbir K Boparai
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Sheila F Castañeda
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Toni Rose Geronimo-Hara
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Teresa M Powell
- Leidos, Inc, San Diego, CA, USA
- Army Resilience Directorate, Headquarters United States Department of the Army, Deputy Chief of Staff G-1, Arlington, VA, USA
| | - Xin M Tu
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, USA
| | - Jennifer L Walstrom
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Beverly D Sheppard
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Ruseckaite R, Mudunna C, Caruso M, Ahern S. Response rates in clinical quality registries and databases that collect patient reported outcome measures: a scoping review. Health Qual Life Outcomes 2023; 21:71. [PMID: 37434146 DOI: 10.1186/s12955-023-02155-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patient Reported Outcome Measures (PROMs) are being increasingly introduced in clinical registries, providing a personal perspective on the expectations and impact of treatment. The aim of this study was to describe response rates (RR) to PROMs in clinical registries and databases and to examine the trends over time, and how they change with the registry type, region and disease or condition captured. METHODS We conducted a scoping literature review of MEDLINE and EMBASE databases, in addition to Google Scholar and grey literature. All English studies on clinical registries capturing PROMs at one or more time points were included. Follow up time points were defined as follows: baseline (if available), < 1 year, 1 to < 2 years, 2 to < 5 years, 5 to < 10 years and 10 + years. Registries were grouped according to regions of the world and health conditions. Subgroup analyses were conducted to identify trends in RRs over time. These included calculating average RRs, standard deviation and change in RRs according to total follow up time. RESULTS The search strategy yielded 1,767 publications. Combined with 20 reports and four websites, a total of 141 sources were used in the data extraction and analysis process. Following the data extraction, 121 registries capturing PROMs were identified. The overall average RR at baseline started at 71% and decreased to 56% at 10 + year at follow up. The highest average baseline RR of 99% was observed in Asian registries and in registries capturing data on chronic conditions (85%). Overall, the average RR declined as follow up time increased. CONCLUSION A large variation and downward trend in PROMs RRs was observed in most of the registries identified in our review. Formal recommendations are required for consistent collection, follow up and reporting of PROMs data in a registry setting to improve patient care and clinical practice. Further research studies are needed to determine acceptable RRs for PROMs captured in clinical registries.
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Affiliation(s)
- Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Chethana Mudunna
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Marisa Caruso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
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Benzeval M, Andrayas A, Mazza J, Al Baghal T, Burton J, Crossley TF, Kumari M. Does the feedback of blood results in observational studies influence response and consent? A randomised study of the Understanding Society Innovation Panel. BMC Med Res Methodol 2023; 23:134. [PMID: 37280544 DOI: 10.1186/s12874-023-01948-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND While medical studies generally provide health feedback to participants, in observational studies this is not always the case due to logistical and financial difficulties, or concerns about changing observed behaviours. However, evidence suggests that lack of feedback may deter participants from providing biological samples. This paper investigates the effect of offering feedback of blood results on participation in biomeasure sample collection. METHODS Participants aged 16 and over from a longitudinal study - the Understanding Society Innovation Panel-were randomised to three arms - nurse interviewer, interviewer, web survey - and invited to participate in biomeasures data collection. Within each arm they were randomised to receive feedback of their blood results or not. For those interviewed by a nurse both venous and dried blood samples (DBS) were taken in the interview. For the other two arms, they were asked if they would be willing to take a sample, and if they agreed a DBS kit was left or sent to them so the participant could take their own sample and return it. Blood samples were analysed and, if in the feedback arms, participants were sent their total cholesterol and HbA1c results. Response rates for feedback and non-feedback groups were compared: overall; in each arm of the study; by socio-demographic and health characteristics; and by previous study participation. Logistic regression models of providing a blood sample by feedback group and data collection approach controlling for confounders were calculated. RESULTS Overall 2162 (80.3% of individuals in responding households) took part in the survey; of those 1053 (48.7%) consented to provide a blood sample. Being offered feedback had little effect on overall participation but did increase consent to provide a blood sample (unadjusted OR 1.38; CI: 1.16-1.64). Controlling for participant characteristics, the effect of feedback was highest among web participants (1.55; 1.11-2.17), followed by interview participants (1.35; 0.99 -1.84) and then nurse interview participants (1.30; 0.89-1.92). CONCLUSIONS Offering feedback of blood results increased willingness to give samples, especially for those taking part in a web survey.
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Affiliation(s)
- Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, UK.
| | - Alexandria Andrayas
- Institute for Social and Economic Research, University of Essex, Colchester, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jan Mazza
- European University Institute, Fiesole, Italy
| | - Tarek Al Baghal
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Jonathan Burton
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | | | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Colchester, UK
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López M. The effect of sampling mode on response rate and bias in elite surveys. Qual Quant 2023; 57:1303-1319. [PMID: 36950269 PMCID: PMC10024663 DOI: 10.1007/s11135-022-01406-9] [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] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
The literature frequently recommends purposive sampling of elites based on the assumptions that random sampling negatively affects the response rate and that it induces bias. I test these assumptions drawing on metadata from 282 samples of political, economic, and social elites, and on microdata from 2,658 elites. First I use permutations to calculate confidence intervals for the expected response rate following each sampling method. Second, I estimate the effect of random sampling on the final response rate using a range of regression models. Finally, I compare the distributions of the estimators for the average age, the share of male elites, and elites' ideology by simulating repeated random and purposive samples. Results indicate that both random and purposive sampling of elites generate sufficiently large samples, as well as consistent and unbiased estimators of population parameters. Contradicting methodological guidelines in the field, the conclusion is that random sampling of elites is efficient.
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Affiliation(s)
- Matias López
- Albert Hirschman Centre On Democracy, Graduate Institute of Geneva, Geneva, Switzerland
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Thakkar KP, Fowler M, Keene S, Iuga A, Dellon ES. Long-term efficacy of proton pump inhibitors as a treatment modality for eosinophilic esophagitis. Dig Liver Dis 2022; 54:1179-1185. [PMID: 35410852 PMCID: PMC9427674 DOI: 10.1016/j.dld.2022.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are a first-line treatment for EoE, but data are limited concerning response durability. We aimed to determine long-term outcomes in EoE patients responsive to PPI-therapy. METHODS We conducted a retrospective cohort study of newly diagnosed adults with EoE who had initial histologic response (<15 eosinophils per high-power-field) to PPI-only therapy. We extracted data regarding their subsequent clinical course and outcomes. We compared findings between the initial PPI-response endoscopy and the final endoscopy, and assessed factors associated with loss of PPI response. RESULTS Of 138 EoE patients with initial histologic response to PPI, 50 had long-term endoscopic follow-up, 40 had clinical follow-up, 10 changed treatments, and 38 had no long-term follow-up. Of those with endoscopic follow-up, mean follow-up-time was 3.6 ± 2.9 years; 30 and 32 patients (60%; 64%) maintained histologic and symptom responses, respectively. However, fibrotic endoscopic findings of EoE were unchanged. Younger age (aOR 1.05, 95% CI: 1.01-1.11) and dilation prior to PPI treatment (aOR 0.21, 95% CI: 0.05-0.83) were the only factors associated with long-term loss of PPI response. CONCLUSIONS Long-term histologic and clinical response rates for PPI therapy were 60% and 64%, respectively. Younger age and dilation at baseline were associated with histologic loss of response. These data can inform long-term EoE treatment selection.
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Affiliation(s)
- Kisan P Thakkar
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building, 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC 27599-7080, USA
| | - Mark Fowler
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Staci Keene
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alina Iuga
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building, 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC 27599-7080, USA; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Molloy J, Castro A, Götschi T, Schoeman B, Tchervenkov C, Tomic U, Hintermann B, Axhausen KW. The MOBIS dataset: a large GPS dataset of mobility behaviour in Switzerland. Transportation (Amst) 2022; 50:1-25. [PMID: 35757094 PMCID: PMC9212210 DOI: 10.1007/s11116-022-10299-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
This article presents the MOBIS dataset and underlying survey methods used in its collection. The MOBIS study was a nation-wide randomised controlled trial (RCT) of transport pricing in Switzerland, utilising a combination of postal recruitment, online surveys, and GPS tracking. 21,571 persons completed the first online survey, and 3680 persons completed 8 weeks of GPS tracking. Many continued tracking for over a year after the study was completed. In the field experiment, participants participated through the use of a GPS tracking app, Catch-my-Day, which logged their daily travel on different transport modes and imputed the trip segments and modes. The experiment lasted 8 weeks, bookended by two online surveys. After the first 4-week control phase, participants were split into two different treatment groups and a continued control group. An analysis of the survey participation shows that the technology is capable of supporting such an experiment on both Android and iOS, the two main mobile platforms. Significant differences in the engagement and attrition were observed between iOS and Android participants over the 8-week period. Finally, the attrition rate did not vary between treatment groups. This paper also reports on the wealth of data that are being made available for further research, which includes over 3 million trip stages and activities, labelled with transport mode and purpose respectively. Supplementary Information The online version contains supplementary material available at 10.1007/s11116-022-10299-4.
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Affiliation(s)
| | | | | | | | | | - Uros Tomic
- INE, Zurich University of Applied Sciences, Winterthur, Switzerland
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Hamadani M, Liao L, Yang T, Chen L, Moskowitz C. Characteristics and Clinical Outcomes of Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma Who Received At Least 3 Lines of Therapies. Clin Lymphoma Myeloma Leuk 2022; 22:373-381. [PMID: 34933826 DOI: 10.1016/j.clml.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The treatment landscape for diffuse large B-cell lymphoma (DLBCL) has recently changed. We examined characteristics and clinical outcomes of DLBCL patients who initiated a third (3L) and fourth (4L) line of therapy during a contemporary time frame. MATERIALS AND METHODS Adult patients diagnosed with DLBCL who received ≥ 3L after January 1, 2014 were selected from the COTA database. Patients were grouped into cohorts by 3L or 4L initiation and further stratified by type of treatment received: chemotherapy or chemoimmunotherapy (CT/CIT), targeted therapy (TT), chimeric antigen receptor T cells (CAR-T), or salvage therapy consolidated with hematopoietic cell transplant (HCT). Patient characteristics, response rates, and overall survival (OS) were examined. RESULTS Among adult patients with relapsed/refractory (r/r) DLBCL, 212 (mean age; 61.8 years; 59.0% male) received their 3L and 127 (mean age: 61.0 years; 61.4% male) their 4L. Among those treated with their 3L and 4L, 55.2% and 50.4%, respectively, received CT/CIT; 26.9% and 34.6% received TT. The complete response rate of 3L patients was 9.4% for CT/CIT, 10.5% for TT, and 60% for CAR-T. Similar findings were seen with 4L patients (CT/CIT: 6.3%; TT: 15.9%; CAR-T: 53.8%). For those who received pharmacological treatment in 3L and 4L, median OS times were 7.7 and 4.4 months, respectively. Median OS times of patients who received cell-based therapies (CAR-T/HCT) were not reached. CONCLUSION In this study, a majority of r/r DLBCL patients were treated with CT/CIT or TT in 3L and 4L settings and had poor clinical outcomes, underscoring the need for more effective treatments.
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Affiliation(s)
- Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Lei Chen
- ADC Therapeutics, New Providence, NJ
| | - Craig Moskowitz
- Miller School of Medicine, University of Miami Health System, Miami, FL
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Gates E, Hole B, Hayward S, Chesnaye NC, Meuleman Y, Dekker FW, Evans M, Heimburger O, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Jager KJ, Roderick P, Caskey F. Converting from face-to-face to postal follow-up and its effects on participant retention, response rates and errors: lessons from the EQUAL study in the UK. BMC Med Res Methodol 2022; 22:44. [PMID: 35148682 PMCID: PMC8832416 DOI: 10.1186/s12874-021-01453-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provides lessons for those who are considering changing their study design. METHODS The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced chronic kidney disease. Initially, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months, known as "traditional follow-up" (TFU). In 2018, all living patients were invited to switch to "efficient follow-up" (EFU), which used an abbreviated questionnaire consisting of SF-12 and Dialysis Symptom Index. These were administered centrally by post. Response rates were calculated using returned questionnaires as a proportion of surviving invitees, and error rates presented as the average percentage of unanswered questions or unclear answers, of total questions in returned questionnaires. Response and error rates were calculated 6-monthly in TFU to allow comparisons with EFU. RESULTS Of the 504 patients initially recruited, 236 were still alive at the time of conversion to EFU; 111 of these (47%) consented to the change in follow-up. In those who consented, median TFU was 34 months, ranging from 0 to 42 months. Their response rates fell steadily from 88% (98/111) at month 0 of TFU, to 20% (3/15) at month 42. The response rate for the first EFU questionnaire was 60% (59/99) of those alive from TFU. With this improvement in response rates, the first EFU also lowered errors to baseline levels seen in early follow-up, after having almost trebled throughout traditional follow-up. CONCLUSIONS Overall, this study demonstrates that administration of shorter follow-up questionnaires by post rather than in person does not negatively impact patient response or error rates. These results may be reassuring for researchers who are trying to limit face-to-face contact with patients during the COVID-19 pandemic.
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Affiliation(s)
- Emer Gates
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Barnaby Hole
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Samantha Hayward
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Olof Heimburger
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Gaetana Porto
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Paul Roderick
- School of Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fergus Caskey
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Querfeld C, Scarisbrick JJ, Assaf C, Guenova E, Bagot M, Ortiz-Romero PL, Quaglino P, Bonizzoni E, Hodak E. Post hoc Analysis of a Randomized, Controlled, Phase 2 Study to Assess Response Rates with Chlormethine/Mechlorethamine Gel in Patients with Stage IA-IIA Mycosis Fungoides. Dermatology 2021; 238:347-357. [PMID: 34091453 DOI: 10.1159/000516138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma. Patients can be treated using chlormethine gel, a skin-directed therapy developed and approved for MF. In the randomized, controlled 201 trial, chlormethine gel was found to be noninferior to equal-strength chlormethine ointment. However, there remains a need to gain more insight into outcome measures after treatment. OBJECTIVE The aim of this study was to further investigate the potential of chlormethine gel treatment through a novel post hoc analysis of the 201 trial data (NCT00168064). METHODS Patients were randomized to chlormethine gel or ointment; response assessments included Composite Assessment of Index Lesion Severity (CAILS) and total body surface area (BSA). In this post hoc analysis, additional subgroup response analyses were performed for stage IA/IB-IIA MF. Very good partial response (75 to <100% improvement) was included as an additional response category. Time to response and overall response trends were determined. Finally, multivariate time-to-event analyses were performed to determine whether associations were observed between treatment frequency, response, and adverse events. RESULTS Response rates were significantly higher for patients with stage IA MF for CAILS (intent-to-treat [p = 0.0014] and efficacy-evaluable [EE; p = 0.0036] populations) and BSA (EE population [p = 0.0488]) treated with gel versus ointment. Time to first CAILS response and response trends were better for all-stage gel-treated patients overall. No association was seen between treatment frequency and response or occurrence of adverse events at the following visit. An association was observed between the occurrence of contact dermatitis and improved clinical response at the next visit (p = 0.0001). CONCLUSION This post hoc analysis shows that treatment with chlormethine gel may result in higher and faster response rates compared with chlormethine ointment, which confirms and expands results reported in the original analysis. The incidence of contact dermatitis may potentially be a prognostic indicator for clinical response; this needs to be confirmed in a larger population.
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Affiliation(s)
| | | | - Chalid Assaf
- Department of Dermatology and Venereology, Helios Klinikum Krefeld, Krefeld, Germany.,Academic Teaching Hospital of the University of Aachen, Aachen, Germany
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Martine Bagot
- Department of Dermatology, AP-HP, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Pablo Luis Ortiz-Romero
- Hospital 12 de Octubre, Institute I+12, CIBERONC, Medical School, Universidad Complutense, Madrid, Spain
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Erminio Bonizzoni
- Department of Clinical Sciences and Community, Section of Medical Statistics, Biometry and Epidemiology, University of Milan, Milan, Italy
| | - Emmilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Gyawali B, Hey SP, Kesselheim AS. Evaluating the evidence behind the surrogate measures included in the FDA's table of surrogate endpoints as supporting approval of cancer drugs. EClinicalMedicine 2020; 21:100332. [PMID: 32382717 PMCID: PMC7201012 DOI: 10.1016/j.eclinm.2020.100332] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In July 2018, the FDA first published a table listing all surrogate measures that it has used, and may accept for future use, in regulatory approval. However, the strength of surrogacy for those measures was not formally assessed. Using the case example of breast cancer, we aimed to evaluate the strength of correlation of surrogate measures listed in the FDA's Table with overall survival. METHODS This cross-sectional study of the FDA's Table of Surrogate Endpoints was conducted in May 2019. All surrogate measures listed in the FDA table as appropriate for accelerated or regular approval for breast cancer were extracted. We identified studies evaluating the correlation of treatment benefit in the surrogate with treatment benefit in overall survival and extracted results from the correlation analysis. FINDINGS Five surrogate endpoints were listed for breast cancer in the FDA website: pathological complete response rates (pCR), event-free survival (EFS), disease-free survival (DFS), objective response rates (ORR), and progression-free survival (PFS), of which pCR was listed as appropriate only for accelerated approval, while the rest were considered appropriate for accelerated or regular approval. No correlation study evaluated the correlation of treatment effects on EFS with that on OS. The results from correlation studies evaluating pCR, DFS, ORR, and PFS suggest that the treatment effects on none of these surrogate measures were strongly correlated with treatment effects on OS (r<0.85 or R2 < 0.7, except for DFS in HER2 positive early breast cancer (R2 = 0.75). INTERPRETATION Using breast cancer as an example, we evaluated the underlying evidence for the surrogate endpoints for solid tumors listed in the FDA's Table of Surrogate Endpoints and found weak or missing correlations of treatment effects on these surrogates with treatment effects on OS . Surrogate measures should be predictive of clinical benefit to be useful in supporting regular FDA approval. FUNDING Work on this project was funded by the Arnold Ventures. Dr. Kesselheim is also supported by the Harvard-MIT Center for Regulatory Science. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Affiliation(s)
- Bishal Gyawali
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, US
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
- Corresponding author.
| | - Spencer P. Hey
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, US
- Harvard Center for Bioethics, Harvard Medical School, Boston, MA, US
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, US
- Harvard Center for Bioethics, Harvard Medical School, Boston, MA, US
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12
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Bulkley JE, O'Keeffe-Rosetti M, Wendel CS, Davis JV, Danforth KN, Harrison TN, Kwan ML, Munneke J, Brooks N, Grant M, Leo MC, Banegas M, Weinmann S, McMullen CK. The effect of multiple recruitment contacts on response rates and patterns of missing data in a survey of bladder cancer survivors 6 months after cystectomy. Qual Life Res 2019; 29:879-889. [PMID: 31811594 DOI: 10.1007/s11136-019-02379-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The Bladder Cancer Quality of Life Study collected detailed and sensitive patient-reported outcomes from bladder cancer survivors in the period after bladder removal surgery, when participation in survey research may present a burden. This paper describes the study recruitment methods and examines the response rates and patterns of missing data. METHODS Detailed surveys focusing on quality of life, healthcare decision-making, and healthcare expenses were mailed to patients 5-7 months after cystectomy. We conducted up to 10 follow-up recruitment calls. We analyzed survey completion rates following each contact in relation to demographic and clinical characteristics, and patterns of missing data across survey content areas. RESULTS The overall response rate was 71% (n = 269/379). This was consistent across patient clinical characteristics; response rates were significantly higher among patients over age 70 and significantly lower among racial and ethnic minority patients compared to non-Hispanic white patients. Each follow-up contact resulted in marginal survey completion rates of at least 10%. Rates of missing data were low across most content areas, even for potentially sensitive questions. Rates of missing data differed significantly by sex, age, and race/ethnicity. CONCLUSIONS Despite the effort required to participate in research, this population of cancer survivors showed willingness to share detailed information about quality of life, health care decision-making, and expenses, soon after major cancer surgery. Additional contacts were effective at increasing participation. Response patterns differed by race/ethnicity and other demographic factors. Our data collection methods show that it is feasible to gather detailed patient-reported outcomes during this challenging period.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Maureen O'Keeffe-Rosetti
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | | | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Kim N Danforth
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Teresa N Harrison
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Marilyn L Kwan
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Julie Munneke
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Marcia Grant
- City of Hope/Beckman Research Institute, Duarte, CA, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Matthew Banegas
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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Yılmaz F, Atilla D, Akkaş N, Bülbül H, Soyer N, Demir D, Kiper D, Avcı A, Vural F, Saydam G, Şahin F, Hekimgil M, Özsan N, Durusoy R, Payzın B. Retrospective Analysis of Hairy Cell Leukemia Patients Treated with Different Modalities as First Line: Real-Life Experience Over 20 years. Indian J Hematol Blood Transfus 2019; 35:692-698. [PMID: 31741621 DOI: 10.1007/s12288-019-01132-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open
Abstract
We aimed to analyze the characteristics and response rates of different treatment modalities in hairy cell leukemia patients over 20 diagnosed as hairy cell leukemia (HCL). Clinical data, response rates and survival outcome of the patients who were diagnosed with HCL were retrospectively analyzed. Fifty-two patients with a median age of 50 (28-87) years were enrolled in the study. 38 patients (73%) were male and male to female ratio was 2.7. First line therapy was cladrabine in 36 patients (69.2%). The overall response rate was 97%. CR and PR rates were 86.1% and 11.1%, respectively. Interferon was used in 10(19.2%) patients who were diagnosed before 2000s years. CR and PR rates were 70% and 30%, respectively. Although the CR rates were lower in IFN group, this difference could not be reached statistically significance (p = 0.24). The median follow up was 48 months (12-252). The median OS was not reached and median PFS was 150 months (95% CI, 116-214). The OS at 36 and 48 months were 95.9% and 92.3%, respectively and the PFS at 36 and 48 months were 90.2% and 83.4%, respectively. After the introduction of purine analogues, the fate of the HCL patients have been changed. Cladrabin achieved very high response rates in both young and older patients, in our study. Although relapse still constitutes a problem, another single dose of cladrabine results in good response rates.
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Affiliation(s)
- Fergün Yılmaz
- 1Department of Hematology, Internal Medicine, Marmara University, Istanbul, Turkey
| | - Dilan Atilla
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Nagihan Akkaş
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
| | - Hale Bülbül
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Nur Soyer
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Derya Demir
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Demet Kiper
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
| | - Aylin Avcı
- 5Department of Pathology, İzmir Katip Celebi University, Izmir, Turkey
| | - Filiz Vural
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Güray Saydam
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Fahri Şahin
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Mine Hekimgil
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Nazan Özsan
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Raika Durusoy
- 6Department of Public Heath, Ege University, Izmir, Turkey
| | - Bahriye Payzın
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
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14
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Miranda Poma J, Ostios Garcia L, Villamayor Sanchez J, D’errico G. What do we know about cancer immunotherapy? Long-term survival and immune-related adverse events. Allergol Immunopathol (Madr) 2019; 47:303-308. [PMID: 29983240 DOI: 10.1016/j.aller.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/21/2018] [Indexed: 01/04/2023]
Abstract
Immunotherapy delivered a new therapeutic option to the oncologist: Ipilimumab (anti-CTLA-4), Nivolumab and Pembrolizumab (anti-PD1), and Atezolizumab (anti-PD-L1) increase overall survival and show a better safety profile compared to chemotherapy in patients with metastatic melanoma, lung, renal cancer among others. But all that glitters is not gold and there is an increasing number of reports of adverse effects while using immune-checkpoint inhibitors. While chemotherapy could weaken the immune system, this novel immunotherapy could hyper-activate it, resulting in a unique and distinct spectrum of adverse events, called immune-related adverse events (IRAEs). IRAEs, ranging from mild to potentially life-threatening events, can involve many systems, and their management is radically different from that of cytotoxic drugs: immunosuppressive treatments, such as corticoids, infliximab or mycophenolate mofetil, usually result in complete reversibility, but failing to do so can lead to severe toxicity or even death. Patient selection is an indirect way to reduce adverse events minimizing the number of subjects exposed to this drugs: unfortunately PDL-1, the actual predictive biomarker, would not allow clinicians select or exclude patients for treatment with checkpoint inhibitors.
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15
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Zheng G, Oksuzyan S, Hsu S, Cloud J, Jewell MP, Shah N, Smith LV, Frye D, Kuo T. Self-Reported Interest to Participate in a Health Survey if Different Amounts of Cash or Non-Monetary Incentive Types Were Offered. J Urban Health 2018; 95:837-49. [PMID: 29654397 DOI: 10.1007/s11524-018-0237-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective of this study was to assess monetary and non-monetary factors that can influence the decision to participate in a future health survey. A questionnaire was administered to eligible, low-income participants (n = 1502) of the 2012 Los Angeles County Health and Nutrition Examination Survey (LAHANES-II). Multivariable regression analyses were performed to describe factors potentially associated with future intent to participate in similar survey designs. The results of the survey suggest that, overall, female participants had a greater interest in participating under a variety of incentive scenarios. Compared to the 25-34 age group, older participants (35-44, 45-84) reported more interest to participate if $10 cash [prepaid gift/debit card], a coupon for product/travel, or a small item [e.g., granola bar, t-shirt, pen] was offered, whereas younger participants (18-24) reported greater interest for $25 cash or a coupon for product/travel. Non-Whites, when compared to Whites/Non-Hispanics, reported greater interest to participate if any of the incentives was offered. High school graduates, when compared to those with some college education, reported greater interest to participate if $10 cash, a small item, or a lottery ticket was offered. Presence of two or more chronic conditions increased interest while concerns about participation in LAHANES-II was associated with reduced interest to participate in future health-related surveys. The results suggest that both incentives and non-monetary considerations (e.g., personal concerns about participating and individual level characteristics) can influence the decision to participate in health-related surveys and offer insights into strategies that can improve response rates for these assessments that are often used to inform community planning.
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16
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Wiant K, Geisen E, Creel D, Willis G, Freedman A, de Moor J, Klabunde C. Risks and rewards of using prepaid vs. postpaid incentive checks on a survey of physicians. BMC Med Res Methodol 2018; 18:104. [PMID: 30305049 PMCID: PMC6180605 DOI: 10.1186/s12874-018-0565-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/29/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survey researchers use monetary incentives as a strategy to motivate physicians' survey participation. Experiments from general population surveys demonstrate that prepaid incentives increase response rates and lower survey administration costs relative to postpaid incentives. Experiments comparing these two incentive strategies have rarely been attempted with physician samples. METHODS A nationally representative sample of oncologists was recruited to participate in the National Survey of Precision Medicine in Cancer Treatment. To determine the optimal strategy for survey incentives, sample members were randomly assigned to receive a $50 prepaid incentive check or a $50 promised (postpaid) incentive check. Outcome measures for this incentives experiment include cooperation rates, speed of response, check-cashing behavior, and comparison of hypothetical costs for different incentive strategies. RESULTS Cooperation rates were considerably higher for sample members in the prepaid condition (41%) than in the postpaid condition (29%). Similar differences in cooperation rates were seen for physicians when stratified by region, size of the physician's metropolitan statistical area, specialty, and gender by age. Survey responders in the prepaid condition responded earlier in the field period than those in the postpaid condition, thus requiring fewer contacts. In the prepaid group, 84% of sample members who responded with a completed survey cashed the incentive check and only 6% of nonresponders cashed the check. In the postpaid condition, 72% of survey responders cashed the check; nonresponders were not given a check. The relatively higher cooperation rates and earlier response of the responders in the prepaid condition was associated with a 30% cost savings for the prepaid condition compared to the postpaid incentive condition. CONCLUSIONS The results of this study suggest that the rewards of offering physicians a prepaid incentive check outweigh the possible risks of nonresponders cashing the check. The relative cost benefit of this strategy is likely to vary depending on the amount of the incentive relative to the costs of additional contact attempts to nonresponders.
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Affiliation(s)
- Kristine Wiant
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Emily Geisen
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Darryl Creel
- RTI International, 6110 Executive Boulevard, Suite 902, Rockville, MD, 20852, USA
| | - Gordon Willis
- National Cancer Institute, 9609 Medical Center Drive, Rm 3E228, MSC 9762, Bethesda, MD, 20892-9762, USA
| | - Andrew Freedman
- National Cancer Institute, 9609 Medical Center Drive, Room 4E226, Rockville, MD, 20850, USA
| | - Janet de Moor
- National Cancer Institute, 9609 Medical Center Drive, Room 3E438, Bethesda, MD, 20892-9764, USA
| | - Carrie Klabunde
- National Institutes of Health, 6100 Executive Boulevard, Suite 2B03, Rockville, MD, 20852, USA
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17
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Mohan D, Rosengart MR, Fischhoff B, Angus DC, Wallace DJ, Farris C, Yealy DM, Barnato AE. Using incentives to recruit physicians into behavioral trials: lessons learned from four studies. BMC Res Notes 2017; 10:776. [PMID: 29282154 PMCID: PMC5745997 DOI: 10.1186/s13104-017-3101-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/24/2017] [Accepted: 12/16/2017] [Indexed: 11/10/2022] Open
Abstract
Objective To describe lessons learned from the use of different strategies for recruiting physicians responsible for trauma triage, we summarize recruitment data from four behavioral trials run in the United States between 2010 and 2016. Results We ran a series of behavioral trials with the primary objective of understanding the influence of heuristics on physician decision making in trauma triage. Three studies were observational; one tested an intervention. The trials used different methods of recruitment (in-person vs. email), timing of the honorarium (pre-paid vs. conditional on completion), type of honorarium [a $100 gift card (monetary reward) vs. an iPad mini 2 (material incentive)], and study tasks (a vignette-based questionnaire, virtual simulation, and intervention plus virtual simulation). We recruited 989 physicians, asking each to complete a questionnaire or virtual simulation online. Recruitment and response rates were 80% in the study where we approached physicians in person, used a pre-paid material incentive, and required that they complete both an intervention plus a virtual simulation. They were 56% when we recruited physicians via email, used a monetary incentive conditional on completion of the task, and required that they complete a vignette-based questionnaire. Trial registration clinicaltrials.gov; NCT02857348
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Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh, 638 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA.
| | | | - Baruch Fischhoff
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh, 638 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
| | - David J Wallace
- Department of Critical Care Medicine, University of Pittsburgh, 638 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
| | | | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amber E Barnato
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Grutzmacher SK, Munger AL, Speirs KE, Zemeir LA, Richard KC, Worthington L. Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program. Eval Program Plann 2017; 64:90-94. [PMID: 28578291 DOI: 10.1016/j.evalprogplan.2017.04.001] [Citation(s) in RCA: 4] [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: 10/11/2016] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n=108-1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10-55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88-99%) and to report positive behaviors (68-100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.
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Affiliation(s)
| | - Ashley L Munger
- California State University, Los Angeles, Los Angeles, CA, United States.
| | | | - Lindsey A Zemeir
- University of Maryland, College Park, Columbia, MD, United States.
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Heerman WJ, Jackson N, Roumie CL, Harris PA, Rosenbloom ST, Pulley J, Wilkins CH, Williams NA, Crenshaw D, Leak C, Scherdin J, Muñoz D, Bachmann J, Rothman RL, Kripalani S. Recruitment methods for survey research: Findings from the Mid-South Clinical Data Research Network. Contemp Clin Trials 2017; 62:50-55. [PMID: 28823925 DOI: 10.1016/j.cct.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 03/20/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of this study was to report survey response rates and demographic characteristics of eight recruitment approaches to determine acceptability and effectiveness of large-scale patient recruitment among various populations. METHODS We conducted a cross sectional analysis of survey data from two large cohorts. Patients were recruited from the Mid-South Clinical Data Research Network using clinic-based recruitment, research registries, and mail, phone, and email approaches. Response rates are reported as patients who consented for the survey divided by the number of eligible patients approached. RESULTS We contacted more than 90,000 patients and 13,197 patients completed surveys. Median age was 56.3years (IQR 40.9, 67.4). Racial/ethnic distribution was 84.1% White, non-Hispanic; 9.9% Black, non-Hispanic; 1.8% Hispanic; and 4.0% other, non-Hispanic. Face-to-face recruitment had the highest response rate of 94.3%, followed by participants who "opted-in" to a registry (76%). The lowest response rate was for unsolicited emails from the clinic (6.1%). Face-to-face recruitment enrolled a higher percentage of participants who self-identified as Black, non-Hispanic compared to other approaches (18.6% face-to-face vs. 8.4% for email). CONCLUSIONS Technology-enabled recruitment approaches such as registries and emails are effective for recruiting but may yield less racial/ethnic diversity compared to traditional, more time-intensive approaches.
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Affiliation(s)
- William J Heerman
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA.
| | - Natalie Jackson
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Christianne L Roumie
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA; Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, 1310 24th Ave S, Nashville, TN 37212, USA
| | - Paul A Harris
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - S Trent Rosenbloom
- Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA; Department of Biomedical Informatics, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - Jill Pulley
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Consuelo H Wilkins
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, 1310 24th Ave S, Nashville, TN 37212, USA; Meharry-Vanderbilt Alliance, 1005 Dr. D.B. Todd Jr. Blvd., Biomedical Building, Nashville, TN 37208, USA; Meharry Medical College, Department of Medicine, 1005 Dr. D.B. Todd Jr. Blvd., Biomedical Building, Nashville, TN 37208, USA
| | | | - David Crenshaw
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Cardella Leak
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Jon Scherdin
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Daniel Muñoz
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Justin Bachmann
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Russell L Rothman
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - Sunil Kripalani
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
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Yu S, Alper HE, Nguyen AM, Brackbill RM, Turner L, Walker DJ, Maslow CB, Zweig KC. The effectiveness of a monetary incentive offer on survey response rates and response completeness in a longitudinal study. BMC Med Res Methodol 2017; 17:77. [PMID: 28446131 PMCID: PMC5406995 DOI: 10.1186/s12874-017-0353-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 02/02/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Achieving adequate response rates is an ongoing challenge for longitudinal studies. The World Trade Center Health Registry is a longitudinal health study that periodically surveys a cohort of ~71,000 people exposed to the 9/11 terrorist attacks in New York City. Since Wave 1, the Registry has conducted three follow-up surveys (Waves 2–4) every 3–4 years and utilized various strategies to increase survey participation. A promised monetary incentive was offered for the first time to survey non-respondents in the recent Wave 4 survey, conducted 13–14 years after 9/11. Methods We evaluated the effectiveness of a monetary incentive in improving the response rate five months after survey launch, and assessed whether or not response completeness was compromised due to incentive use. The study compared the likelihood of returning a survey for those who received an incentive offer to those who did not, using logistic regression models. Among those who returned surveys, we also examined whether those receiving an incentive notification had higher rate of response completeness than those who did not, using negative binomial regression models and logistic regression models. Results We found that a $10 monetary incentive offer was effective in increasing Wave 4 response rates. Specifically, the $10 incentive offer was useful in encouraging initially reluctant participants to respond to the survey. The likelihood of returning a survey increased by 30% for those who received an incentive offer (AOR = 1.3, 95% CI: 1.1, 1.4), and the incentive increased the number of returned surveys by 18%. Moreover, our results did not reveal any significant differences on response completeness between those who received an incentive offer and those who did not. Conclusions In the face of the growing challenge of maintaining a high response rate for the World Trade Center Health Registry follow-up surveys, this study showed the value of offering a monetary incentive as an additional refusal conversion strategy. Our findings also suggest that an incentive offer could be particularly useful near the end of data collection period when an immediate boost in response rate is needed.
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Affiliation(s)
- Shengchao Yu
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA.
| | - Howard E Alper
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Angela-Maithy Nguyen
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Lennon Turner
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Deborah J Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Carey B Maslow
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
| | - Kimberly C Zweig
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 125 Worth Street, 10th Floor, New York City, NY, 10013, USA
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Barra M, Simonsen TB, Dahl FA. Pre-contact by telephone increases response rates to postal questionnaires in a population of stroke patients: an open ended randomized controlled trial. BMC Health Serv Res 2016; 16:506. [PMID: 27654008 PMCID: PMC5031317 DOI: 10.1186/s12913-016-1732-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background A follow-up study on a cohort of stroke patients through a postal survey questionnaire 3 and 12 months after discharge from hospital was performed. The response rate at 3-months follow-up was lower than desired, and pre-contact by phone as a measure for increasing the response rate at 12 months was studied. Methods The study design was a randomized controlled trial on a cohort of 3 months follow-up-non-responders where the intervention group was pre-contacted with an aim to obtain an informal ’consent to receive’ the questionnaire before the 12-months survey was mailed, and the control group was not. The primary outcome was 45 days response rate; secondary outcome was 365 days response rate. The main analysis followed the intention to treat principle. A secondary, per-protocol analysis (i.e. subjects who were not reached by phone were reassigned to the control group) is included. Also included is a rudimentary cost-utility analysis, where we estimated the cost per additional response. Results Of the 235 subjects, 116 were randomized to the intervention group and 119 to the control group. 10 were excluded due to death (7 in the IG and 3 in the CG), 6 due to dementia (3 in the IG and 3 in the CG), and 2 (1 in the IG and 1 in the CG) for other reasons. The primary outcome was a response rate of 42.9 % in the intervention group, and 26.8 % in the control group, giving p =0.014, with estimated OR of 2.04 (95 % CI [1.16,3.64]). The secondary outcome had p =0.009 with OR 2.10 (95 % CI [1.20,3.70]). The as-per-protocol analyses gave stronger results with p =0.001 and p =0.003, respectively. The cost-utility analysis gave a time cost of 1 working hour per additional response. Conclusions The results are in line with previous research, and show that pre-contact has a positive effect on response rate also for a population of elderly with reduced health. Given the importance of high response rate in surveys, a cost of 1 working hour per additional response is likely to be worth while. Trial registration Registration with ISRCTN initiated on 05/21/2013 and finalised on 06/30/2014 with http://www.isrctn.com/ISRCTN31304930. Following the prospective submission in May 2013, there were no subsequent changes to the protocol. The recruitment started on 01/06/13, after initiation of public registration.
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Affiliation(s)
- Mathias Barra
- Akershus University Hospital, Health Services Research Center, Sykehusveien 25, Lørenskog, 1473, Norway.
| | - Tone Breines Simonsen
- Akershus University Hospital, Health Services Research Center, Sykehusveien 25, Lørenskog, 1473, Norway
| | - Fredrik Andreas Dahl
- Akershus University Hospital, Health Services Research Center, Sykehusveien 25, Lørenskog, 1473, Norway
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Bray I, Noble S, Robinson R, Molloy L, Tilling K. Mode of delivery affected questionnaire response rates in a birth cohort study. J Clin Epidemiol 2017; 81:64-71. [PMID: 27663611 DOI: 10.1016/j.jclinepi.2016.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
Objectives Cohort studies must collect data from their participants as economically as possible, while maintaining response rates. This randomized controlled trial investigated whether offering a choice of online or paper questionnaires resulted in improved response rates compared with offering online first. Study Design and Setting Eligible participants were young people in the Avon Longitudinal Study of Parents and Children (ALSPAC) study (born April 1, 1991, to December 31, 1992, in the Avon area). After exclusions, 8,795 participants were randomized. The “online first” group were invited to complete the questionnaire online. The “choice” group were also sent a paper questionnaire and offered a choice of completion method. The trial was embedded within routine data collection. The main outcome measure was the number of questionnaires returned. Data on costs were also collected. Results Those in the “online first” arm of the trial were less likely to return a questionnaire [adjusted odds ratio: 0.90; 95% confidence interval (CI): 0.82, 0.99]. The “choice” arm was more expensive (mean difference per participant £0.71; 95% CI: £0.65, £0.76). It cost an extra £47 to have one extra person to complete the questionnaire in the “choice” arm. Conclusion Offering a choice of completion methods (paper or online) for questionnaires in ALSPAC increased response rates but was more expensive than offering online first.
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Binkley T, Beare T, Minett M, Koepp K, Wey H, Specker B. Response to an Online Version of a PRAMS-like Survey in South Dakota. Matern Child Health J 2017; 21:335-42. [PMID: 27461019 DOI: 10.1007/s10995-016-2118-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives Increasing response rates for research surveys is challenging, especially in minority populations. A unique minority group in South Dakota is the American Indian (AI) representing about 9 % of the state's population and 15 % of the births. The purpose of this study was to determine race differences among White, AI, and Other Races (OR) in contact, participation, and response rates in the South Dakota Pregnancy Risk Assessment Monitoring System (SDPRAMS). We determined response rates of an online version and evaluated demographic characteristics associated with online response. Methods The SDPRAMS was sent to 1814 mothers randomly sampled from 2014 birth certificate files. Results The weighted response rate was 71.3 %, and varied significantly among the three races: 79.1 % for White race, 48.6 % for AI race, and 60.6 % for OR (p < 0.01). A higher percent of White mothers responded online than AI and OR (35, 25 and 26 %, respectively; p = 0.001); no difference between AI and OR. Online responders were more likely to be married, educated beyond high school and having annual incomes ≥$25,000 (p ≤ 0.01 for all), but only education (p < 0.001) and income (p = 0.05) remained significant in the logistic models. 26 % of White, 43 % of AI, and 46 % of OR online respondents used a smartphone to respond (p = 0.01). Conclusions Response rates differed among races. An online version of the PRAMS is a viable method of response to offer participants. Response to the online version via smartphone may increase response from minority populations, emphasizing the importance of mobile friendly formats.
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Bodewes AJ, Kunst AE. Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands. BMC Res Notes 2016; 9:319. [PMID: 27328767 PMCID: PMC4915185 DOI: 10.1186/s13104-016-2124-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands. Methods We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis. Results The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies. Conclusions The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.
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Affiliation(s)
- Adee J Bodewes
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Abstract
When the Black Women's Health Study, a prospective cohort of over 59,000 women who have been followed since 1995, invited all of its participants to provide a DNA sample for future research, only 51 % of those participants agreed to do so. Responders were significantly older and more health conscious than non-responders. The Black Women's Health Study is a unique resource, but this low level of response and its resulting self-selection bias are now the norm in contemporary epidemiologic, and especially cohort, studies. Epidemiology desperately needs new approaches that work better and cost less. The literature on predictors of response focuses too narrowly on participant characteristics and does not identify any clear steps studies can take to increase participation. To improve research quality, cost-efficiency, and long-term sustainability of studies, epidemiology can and should approach, analyze, and leverage response-rate data more creatively and extensively than most studies have done to date.
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Affiliation(s)
- James V Lacey
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010-3000, USA.
| | - Kristen E Savage
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA, 91010-3000, USA
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Bauman A, Phongsavan P, Cowle A, Banks E, Jorm L, Rogers K, Jalaludin B, Grunseit A. Maximising follow-up participation rates in a large scale 45 and Up Study in Australia. Emerg Themes Epidemiol 2016; 13:6. [PMID: 27087827 PMCID: PMC4832455 DOI: 10.1186/s12982-016-0046-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/01/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The issue of poor response rates to population surveys has existed for some decades, but few studies have explored methods to improve the response rate in follow-up population cohort studies. METHODS A sample of 100,000 adults from the 45 and Up Study, a large population cohort in Australia, were followed up 3.5 years after the baseline cohort was assembled. A pilot mail-out of 5000 surveys produced a response rate of only 41.7 %. This study tested methods of enhancing response rate, with three groups of 1000 each allocated to (1) receiving an advance notice postcard followed by a questionnaire, (2) receiving a questionnaire and then follow-up reminder letter, and (3) both these strategies. RESULTS The enhanced strategies all produced an improved response rate compared to the pilot, with a resulting mean response rate of 53.7 %. Highest response was found when both the postcard and questionnaire reminder were used (56.4 %) but this was only significantly higher when compared to postcard alone (50.5 %) but not reminder alone (54.1 %). The combined approach was used for recruitment among the remaining 92,000 participants, with a resultant further increased response rate of 61.6 %. CONCLUSIONS Survey prompting with a postcard and a reminder follow-up questionnaire, applied separately or combined can enhance follow-up rates in large scale survey-based epidemiological studies.
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Affiliation(s)
- Adrian Bauman
- Prevention Research Collaboration, Level 6 Charles Perkins Centre D17, Sydney School of Public Health, University of Sydney, Sydney, NSW 2006 Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Level 6 Charles Perkins Centre D17, Sydney School of Public Health, University of Sydney, Sydney, NSW 2006 Australia
| | - Alison Cowle
- Sax Institute, University of Technology, PO Box K617, Haymarket, NSW 1240 Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Acton, ACT 0200 Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Kris Rogers
- The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050 Australia
| | - Bin Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia ; Centre for Research, Evidence Management and Surveillance, Locked Bag 7279, Liverpool, NSW 1871 Australia
| | - Anne Grunseit
- Prevention Research Collaboration, Level 6 Charles Perkins Centre D17, Sydney School of Public Health, University of Sydney, Sydney, NSW 2006 Australia
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Young JM, O'Halloran A, McAulay C, Pirotta M, Forsdike K, Stacey I, Currow D. Unconditional and conditional incentives differentially improved general practitioners' participation in an online survey: randomized controlled trial. J Clin Epidemiol 2014; 68:693-7. [PMID: 25450450 DOI: 10.1016/j.jclinepi.2014.09.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 05/28/2014] [Revised: 09/08/2014] [Accepted: 09/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the impact of unconditional and conditional financial incentives on response rates among Australian general practitioners invited by mail to participate in an online survey about cancer care and to investigate possible differential response bias between incentive groups. STUDY DESIGN AND SETTING Australian general practitioners were randomly allocated to unconditional incentive (book voucher mailed with letter of invitation), conditional incentive (book voucher mailed on completion of the online survey), or control (no incentive). Nonresponders were asked to complete a small subset of questions from the online survey. RESULTS Among 3,334 eligible general practitioners, significantly higher response rates were achieved in the unconditional group (167 of 1,101, 15%) compared with the conditional group (118 of 1,111, 11%) (P = 0.0014), and both were significantly higher than the control group (74 of 1,122, 7%; both P < 0.001). Although more positive opinions about cancer care were expressed by online responders compared with nonresponders, there was no evidence that the magnitude of difference varied by the incentive group. The incremental cost for each additional 1% increase above the control group response rate was substantially higher for the unconditional incentive group compared with the conditional incentive group. CONCLUSION Both unconditional and conditional financial incentives significantly increased response with no evidence of differential response bias. Although unconditional incentives had the largest effect, the conditional approach was more cost-effective.
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Affiliation(s)
- Jane M Young
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, Level 6 North, Lifehouse (C39Z), NSW 2006, Sydney, Australia.
| | - Anna O'Halloran
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, Level 6 North, Lifehouse (C39Z), NSW 2006, Sydney, Australia
| | - Claire McAulay
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, Level 6 North, Lifehouse (C39Z), NSW 2006, Sydney, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC 3053, Australia
| | - Kirsty Forsdike
- Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC 3053, Australia
| | - Ingrid Stacey
- Cancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Everleigh, NSW 2015, Australia
| | - David Currow
- Cancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Everleigh, NSW 2015, Australia
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Mansfield AS, Symanowski JT, Peikert T. Systematic review of response rates of sarcomatoid malignant pleural mesotheliomas in clinical trials. Lung Cancer 2014; 86:133-6. [PMID: 25217189 DOI: 10.1016/j.lungcan.2014.08.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 06/18/2014] [Revised: 08/18/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022]
Abstract
RATIONALE Malignant pleural mesothelioma is an almost universally fatal malignancy primarily related to asbestos exposure. Based on the differences in immunologic markers and gene expression between histologic subtypes of mesothelioma, and our clinical impression that response rates vary by histology, we decided to examine the reported response rates of mesothelioma subtypes. OBJECTIVES Our objective was to compare the response rates of sarcomatoid mesotheliomas to the overall response rates in published clinical trials. METHODS We searched PubMed for "mesothelioma" with the clinical trials filter selected. We included articles published between January 1, 2000 and March 20, 2014 in which subjects received first or second line systemic therapy for malignant pleural mesothelioma. Studies investigating multi-modality therapy including surgery were excluded. Response rates [including 95% confidence intervals (95% CI)] were estimated for the entire patient cohort and then separately for subjects with sarcomatoid tumors. MEASUREMENTS AND MAIN RESULTS We reviewed 544 publications of which 41 trials met our inclusion criteria. Eleven of these trials did not include patients with sarcomatoid mesothelioma (27% of eligible studies). The remaining 30 publications included 1475 subjects, 1011 with epithelioid tumors (68.5%), 203 with biphasic tumors (13.8%), 137 with sarcomatoid tumors (9.3%) and 124 with unknown subtypes (8.4%). In total, there were 323 responses (21.9%, complete and partial responses, 95% CI: 16.3, 28.8) to systemic therapy across all histological subtypes. In patients with sarcomatoid tumors (n=137) 19 responses were observed. This accounted for 5.9% of all responses and yields a 13.9% (95% CI: 8.6, 21.6) response rate for patients with sarcomatoid tumors. Multiple biases likely affected this systematic review. CONCLUSION Response rates for different histological subtypes of malignant pleural mesothelioma are infrequently reported. Partial and complete responses to systemic therapies appear to be less common among patients with sarcomatoid tumors.
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Affiliation(s)
- Aaron S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
| | - James T Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute Carolinas HealthCare System, Charlotte, NC, United States
| | - Tobias Peikert
- Department of Internal Medicine, Division of Pulmonary Medicine, Mayo Clinic, Rochester, MN, United States
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Bakan J, Chen B, Medeiros-Nancarrow C, Hu JC, Kantoff PW, Recklitis CJ. Effects of a gift certificate incentive and specialized delivery on prostate cancer survivors' response rate to a mailed survey: a randomized-controlled trial. J Geriatr Oncol 2014; 5:127-32. [PMID: 24495697 DOI: 10.1016/j.jgo.2013.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/10/2013] [Accepted: 11/25/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Most men diagnosed with prostate cancer become long-term survivors, but are at risk for medical late-effects that can affect their long-term health. Mailed surveys are well suited to study late-effects in this population, but low response rates can compromise survey validity. This study investigated whether an unconditional $5.00 gift certificate incentive or Priority Mail delivery increased prostate cancer survivors' response to mailed surveys. MATERIALS AND METHODS 976 participants (mean age = 66.8 years), 2-8 years post-diagnosis, were randomized to one of four groups: Incentive; Priority Mail; Incentive & Priority Mail; or Control. After an introductory letter, initial study packets were mailed based on randomization; 46 days later, a second study packet was mailed to all non-responders by First-Class Mail. RESULTS The first mailing yielded a significant variation in response rates across groups (χ(2) = 9.34; p = 0.025). Priority Mail (64.7%; p = 0.008) and Incentive & Priority Mail (63.6%; p = 0.016) groups had significantly higher response rates than Controls (52.9%). After the second mailing, the overall response rate increased significantly from 59.6% to 71.4% (p < 0.001); however, response rates no longer differed across groups (range, 69.3% [Incentive group] to 73.9% [Priority Mail group]). CONCLUSIONS Long-term prostate cancer survivors' response rates to mailed surveys increased with the use of Priority Mail and a repeat survey mailing, but the unconditional gift certificate incentive was not supported in this population. By identifying and applying specialized survey methods, studies targeting survivors of prostate cancer and other geriatric cancers may improve response rates, thus limiting a source of potential bias.
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Fear NT, Van Staden L, Iversen A, Hall J, Wessely S. 50 ways to trace your veteran: increasing response rates can be cheap and effective. Eur J Psychotraumatol 2010; 1:EJPT-1-5516. [PMID: 22893795 PMCID: PMC3401995 DOI: 10.3402/ejpt.v1i0.5516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/11/2010] [Accepted: 10/22/2010] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND while low response rates need not introduce bias into research, having a lower percentage of responders does increase the potential for this to occur. This is of particular concern given the decline that has been occurring in response rates since the 1950s. However, there are various methods that can be incorporated into the study design, which can assist in increasing levels of participation. OBJECTIVE To outline the methods used by the King's Centre for Military Health Research (KCMHR) when conducting a recent telephone survey of serving and ex-Service military personnel. DESIGN Using participants who had already taken part in a questionnaire-based study on the health effects of serving in the UK Armed Forces (n=10,272), a subsample was selected for an in-depth telephone interview-based follow-up study. The subsample consisted of 1,105 participants, selected on the basis of their mental health status. An adjusted response rate of 76% was achieved (n=821). RESULTS Various methods of contact were used in this study to ensure an adequate response rate was achieved. CONCLUSIONS Simple research strategies increase response rates and are likely to reduce bias. Use of multiple simultaneous tracing methods and customisation of the approach to the target population increases rapport between participants, ensuring that those who take part feel valued as members of the study. In the current climate of decreasing participation in studies, research teams need to engage with their study population and devise innovative strategies to keep participants involved in the research being undertaken.
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