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Brown RF, Davis R, Wilson Genderson M, Grant S, Cadet D, Lessard M, Alpert J, Ward J, Ginder G. African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial-the TACT study protocol. BMJ Open 2016; 6:e012864. [PMID: 27986738 PMCID: PMC5168644 DOI: 10.1136/bmjopen-2016-012864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician-patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. OBJECTIVE (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. METHODS AND ANALYSIS First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different 'depths' of tailoring and (2) either providing feedback to oncologists about the patients' trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. ETHICS AND DISSEMINATION This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene 'user groups' at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations. TRIAL REGISTRATION NUMBER NCT02356549.
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Affiliation(s)
- R F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - R Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - M Wilson Genderson
- Siminoff Research Group, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - S Grant
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - D Cadet
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - M Lessard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Alpert
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Ward
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - G Ginder
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Smith SM, Gewandter JS, Kitt RA, Markman JD, Vaughan JA, Cowan P, Kopecky EA, Malamut R, Sadosky A, Tive L, Turk DC, Dworkin RH. Participant Preferences for Pharmacologic Chronic Pain Treatment Trial Characteristics: An ACTTION Adaptive Choice-Based Conjoint Study. THE JOURNAL OF PAIN 2016; 17:1198-1206. [PMID: 27555429 DOI: 10.1016/j.jpain.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 07/26/2016] [Indexed: 12/01/2022]
Abstract
Barriers to clinical trial recruitment can delay study completion, potentially resulting in increased costs and an unrepresentative sample. In the current study of 150 participants with chronic pain, we used a computerized adaptive choice-based conjoint survey that included 8 characteristics that may affect enrollment in pharmacologic pain treatment trials (ie, treatment allocation, frequency of pain ratings, treatment administration method, current medications, number of study visits, availability of evening and weekend visits, invasiveness of laboratory procedures, payment). These data were analyzed using Sawtooth Software ver. 8.4.8 (Sawtooth Software, Inc, Orem, UT), which identifies the characteristics that dominate participants' decisions across multiple sets of potential trials. Three characteristics had the largest relative importance in participants' trial preferences: 1) invasiveness of required laboratory procedures (ie, 22%), with no procedures or blood tests preferred over ice-water sensory testing or skin biopsy; 2) ability to continue current pain medications (21%); and 3) payment for study participation (21%), with higher payment preferred. The fourth most important characteristic was number of study visits (13%), with participants preferring fewer in-person visits and more phone contacts. Understanding the preferences of potential participants is an important step toward enhancing enrollment in pain treatment trials. PERSPECTIVE This article presents the preferences of individuals with chronic pain conditions regarding modifiable pain treatment trial characteristics (eg, number of study visits, payment, treatment allocation). These findings may help to improve enrollment into analgesic clinical trials and in turn accelerate the development of new pain treatments.
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Affiliation(s)
- Shannon M Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Rachel A Kitt
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - John D Markman
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Janet A Vaughan
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | | | | | | | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Neurology, and Psychiatry, and Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Le Du F, Fujii T, Park M, Liu D, Hsu L, Gonzalez-Angulo AM, Ueno NT. Impact of clinical trial on survival outcomes. Breast Cancer Res Treat 2016; 159:273-81. [PMID: 27530453 DOI: 10.1007/s10549-016-3942-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
The number of patients with breast cancer who participate in therapeutic clinical trials remains low. One reason is a lack of opportunity; another is health care providers who do not recommend trials because they fear poorer outcome from the use of new drugs. Thus, we compared survival outcome in patients with metastatic breast cancer (MBC) who participated in first-line therapeutic clinical trials with outcome in patients who had never enrolled in a clinical trial and received only standard care. We hypothesized that first-line therapeutic clinical trials does not have a negative survival outcome. We reviewed the records of patients with MBC who were treated at MD Anderson Cancer Center between January 2000, and December 2010. The medical records of 5501 patients with MBC were screened, and 652 patients-285 in the trial arm and 367 in the control arm-met our specific eligible criteria. The median follow-up of our cohort was 7.16 years (95 % confidence interval [CI] 6.53-7.64 years). Among the global population, no significant differences in progression-free survival (PFS) or overall survival (OS) were observed between the treatment arms: for the clinical trial cohort, median PFS was 7 months (95 % CI 5.72-8.71 months), and median OS was 28.48 months (95 % CI 22.70-34.60 months). For the control cohort, median PFS was 10.02 months (95 % CI 7.13-11.99 months), and median OS was 28.71 months (95 % CI 24.41-31.31 months) (P = .089 and .335, respectively). Enrollment in first-line MBC therapeutic clinical trials does not result in less favorable survival outcome than that in MBC patients who never enrolled in a clinical trial.
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Takeo Fujii
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Limin Hsu
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | - Ana M Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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Dorsey ER, Wagner JD, Bull MT, Rizzieri A, Grischkan J, Achey MA, Sherer T, Chowdhury S, Meunier C, Cappelletti L, Rocker C, Richard IH, Schwarz H, Kang G, Ahmad SH, Biemiller RA, Biglan KM. Feasibility of Virtual Research Visits in Fox Trial Finder. JOURNAL OF PARKINSONS DISEASE 2016; 5:505-15. [PMID: 26406130 PMCID: PMC4923707 DOI: 10.3233/jpd-150549] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Fox Trial Finder is an online registry for individuals with and without Parkinson disease (PD) interested in participating in PD research. However, distance or disability could prevent such individuals from participating in traditional, clinic-based research at major centers. Objective: Use videoconferencing to connect participants to specialists to: (1) demonstrate feasibility of virtual research visits within this population (2) collect phenotypic data of the participants, (3) validate self-reported diagnosis, and (4) gauge interest in virtual research visits. Methods: We solicited volunteers throughout the United States through Fox Trial Finder. Interested individuals with PD provided consent, were given web cameras if needed, completed baseline surveys, and downloaded videoconferencing software remotely. Participants had a test connection and assessment appointment which included the Montreal Cognitive Assessment (MoCA), then a virtual research visit with a neurologist who reviewed their history and assessed their PD using a modified Movement Disorders Society Unified Parkinson’s Disease Rating Scale. Neurologists assessed PD diagnosis and symptomatology. Physicians and participants were surveyed about their experience. Results: Of 204 individuals who consented, 166 (81% ) individuals from 39 states completed all visits. The mean age was 62 and mean disease duration was 8.0 years. Mean MoCA score was 26.5, and mean modified MDS-UPDRS motor score was 22.8 (out of a possible 124). Neurologists judged PD as the most likely diagnosis in 97% of cases. Overall satisfaction with the visits was 79% (satisfied or very satisfied) among neurologists and 93% among participants. Conclusions: Through virtual research visits, neurologists engaged, characterized, and validated self-reported diagnosis in individuals with PD over a broad geography. This model may facilitate future research participation.
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Affiliation(s)
- E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States.,CHET, University of Rochester Medical Center, Rochester, New York, United States
| | | | - Michael T Bull
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | | | - Justin Grischkan
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Meredith A Achey
- CHET, University of Rochester Medical Center, Rochester, New York, United States
| | - Todd Sherer
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Sohini Chowdhury
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Claire Meunier
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Lily Cappelletti
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Charlotte Rocker
- The Michael J. Fox Foundation For Parkinson's Research, New York, United States
| | - Irene H Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Heidi Schwarz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Gail Kang
- University of California Berkeley, Berkeley, California, United States
| | - Stacy H Ahmad
- Department of Cell Biology and Pathology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rachel A Biemiller
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - Kevin M Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States.,CHET, University of Rochester Medical Center, Rochester, New York, United States
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Tesson S, Sundaresan P, Ager B, Butow P, Kneebone A, Costa D, Woo H, Pearse M, Juraskova I, Turner S. Knowledge, attitudes and decision-making preferences of men considering participation in the TROG RAVES Prostate Cancer Trial (TROG 08.03). Radiother Oncol 2016; 119:84-90. [PMID: 26867970 DOI: 10.1016/j.radonc.2016.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/01/2016] [Accepted: 01/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The RAVES (Trans-Tasman Radiation Oncology Group 08.03) randomised controlled trial (RCT), compares adjuvant radiotherapy with early salvage radiotherapy in men with high risk histopathological features at prostatectomy. The RAVES Decision Aid study evaluates the utility of a decision aid for men considering participation in the RAVES RCT. We report the RAVES Decision Aid study participants' attitudes and knowledge regarding RCTs, decision-making preferences and decisional-conflict. MATERIALS AND METHODS Baseline questionnaires assessed knowledge and attitudes towards RCTs and RAVES RCT. Sociodemographic and clinical predictors of knowledge were examined. Involvement in decision-making and difficulties with the decision-making process were assessed using validated tools. RESULTS 127 men (median age=63years) were recruited through urologists (n=91) and radiation oncologists (n=36). Men preferred collaborative (35%) or semi-active (35%) decision-making roles. Most (>75%) felt the RAVES RCT was worthwhile and important with participation being wise. However, nearly half had high decisional-conflict regarding participation. Scores of objective knowledge regarding RCTs and RAVES RCT were low. CONCLUSIONS Most men with high-risk histopathological features at prostatectomy desire active involvement in decision-making regarding further management. Despite positive attitudes towards RCTs and the RAVES RCT, there were gaps in knowledge and high decisional-conflict surrounding participation.
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Affiliation(s)
- Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Puma Sundaresan
- Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.
| | - Brittany Ager
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Andrew Kneebone
- Sydney Medical School, The University of Sydney, Australia; Northern Sydney Cancer Centre, Australia
| | - Daniel Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Australia
| | - Henry Woo
- Sydney Adventist Hospital Clinical School, The University of Sydney, Australia
| | | | - Ilona Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Australia
| | - Sandra Turner
- Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Australia
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56
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Brandberg Y, Johansson H, Bergenmar M. Patients' knowledge and perceived understanding - Associations with consenting to participate in cancer clinical trials. Contemp Clin Trials Commun 2015; 2:6-11. [PMID: 29736441 PMCID: PMC5935834 DOI: 10.1016/j.conctc.2015.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022] Open
Abstract
Recruitment to clinical trials is essential. The aims of the study were to investigate associations between patients' informed consent to participate in a cancer clinical trial and knowledge and perceived understanding of the trial. Furthermore, associations between demographic factors and consent to participate and knowledge and perceived understanding of information about the trial were studied. Methods The patients were recruited in connection to a visit at the oncology clinic for information about a drug trial. The Quality of Informed Consent questionnaire was mailed to the patients after they had decided about participation in the trial. The associations of demographic factors and "knowledge" and "perceived understanding" were analysed using linear regression models. Results A total of 125 patients were included. Higher levels of "knowledge" and "understanding" were found to be associated with consent to participate in a clinical trial, both in the univariate and multivariate analyses (p = 0.001). None of the tested demographic factors were related to consent to participate. No statistically significant associations between any of the demographic factors and knowledge or perceived understanding scores were found. Conclusion The results indicate that interventions that increase patients' knowledge and perceived understanding might improve participation rates in clinical trials.
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Affiliation(s)
- Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Mia Bergenmar
- Department of Oncology-Pathology, Karolinska Institutet Z1:00, Karolinska University Hospital, SE-17176 Stockholm, Sweden
- Center for Digestive Diseases, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
- Corresponding author. Department of Digestive Diseases, Karolinska University Hospital, Huddinge K53, SE-141 86 Stockholm, Sweden.
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Gorini A, Mazzocco K, Pravettoni G. Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence. Public Health Genomics 2015; 18:359-65. [PMID: 26529420 DOI: 10.1159/000441559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials.
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Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, and European Institute of Oncology, Milan, Italy
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Pan IW, Ferguson SD, Lam S. Patient and treatment factors associated with survival among adult glioblastoma patients: A USA population-based study from 2000-2010. J Clin Neurosci 2015; 22:1575-81. [PMID: 26122381 DOI: 10.1016/j.jocn.2015.03.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
In this study, we utilized the USA surveillance, epidemiology, and end results (SEER) database to examine factors influencing survival of glioblastoma multiforme (GBM) patients. GBM is the most common primary malignant brain tumor in adults and despite advances in treatment, prognosis remains poor. Using the SEER database, we defined a cohort of adult patients for the years 2000-2009 with confirmed GBM and minimum follow-up of 12 months. A total of 14,675 patients with GBM met the inclusion criteria. Demographic, clinical, and treatment variables were examined. Death was the primary outcome. Median survival time was 11 months. Patients had increasingly longer survival over the decade span. We found, on multivariate analysis, that significantly worse survival was associated with age >75 years, male sex, unmarried status, and non-Hispanic Caucasian race/ethnicity. Patients in the Northeast had a significantly lower risk of mortality. Patients with tumors that were non-lateralized and >3 cm fared worse. Patients who did not receive adjuvant radiation also had worse outcomes. Gross total resection imparted a survival advantage for patients compared to biopsy or partial resection. Thus, this report adds to the growing body of literature supporting the positive role of maximal resection on patient survival.
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Affiliation(s)
- I-Wen Pan
- Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1230, Houston, TX 77030, USA; Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1230, Houston, TX 77030, USA; Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1230, Houston, TX 77030, USA; Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.
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Dillard JP, Meyer BJF, Solomon DH, Manni A. Factors associated with participation in a prevention trial aimed at reducing biomarkers of breast cancer risk. PATIENT EDUCATION AND COUNSELING 2015; 98:640-644. [PMID: 25659524 DOI: 10.1016/j.pec.2015.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/17/2014] [Accepted: 01/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Poor enrollment into prevention trials is a major obstacle to the conduct of clinical investigations. This study focuses on cognitive and affective influences on the decision to participate in a clinical trial aimed at reducing biomarkers of breast cancer risk. METHODS Following a decision to participate or not in a clinical trial focused on reduction of breast cancer risk, women were recruited into the present study. Data were gathered via telephone survey. RESULTS One hundred healthy women took part in the current study, 72 of whom had participated in the clinical trial, and 28 of whom had declined participation. Women who decided to enroll perceived more benefits and fewer costs, and they experienced more positive emotions and fewer negative emotions. They also made the decision more quickly, more easily, were more satisfied with it, and had fewer regrets than women who declined participation in the clinical trial. CONCLUSIONS Participants to this clinical trial differed from nonparticipants in terms of antecedents, process, and outcomes of the decision to enroll. PRACTICE IMPLICATIONS Although obstacles exist, accrual might be improved by greater emphasis on the practical and psychosocial benefits to participants.
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Affiliation(s)
- James Price Dillard
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, USA.
| | - Bonnie J F Meyer
- Department of Education Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, USA
| | - Denise H Solomon
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, USA
| | - Andrea Manni
- Division of Endocrinology, Diabetes, and Metabolism, The Pennsylvania State University, Hershey Medical Center, Hershey, USA
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Trantham LC, Carpenter WR, DiMartino LD, White B, Green M, Teal R, Corbie-Smith G, Godley PA. Perceptions of Cancer Clinical Research Among African American Men in North Carolina. J Natl Med Assoc 2015; 107:33-41. [PMID: 26113749 PMCID: PMC4477827 DOI: 10.1016/s0027-9684(15)30007-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ACKNOWLEDGEMENTS The authors are grateful to the men and women who participated in our Focus Groups and shared with us their very personal cancer experience. Their insight is valuable, and will inform and improve cancer care for future generations. The authors thank the Greensboro area Community Research Advocates - especially April Durr, Elvira Mebane, Marie McAdoo, Kathy Norcott, and Cindy Taylor - who assisted in the conduct of the study, including interpretation of results. They also thank Gratia Wright of First Research Group for her expertise in moderating and executing all of the focus groups, and Lindsey Haynes-Maslow for her assistance in responding to reviewer comments. The study was funded as a part of the Carolina Community Network program, funded by a grant from the National Cancer Institute (U01-CA114629). This study was reviewed and approved by the Institutional Review Board (IRB) at the University of North Carolina at Chapel Hill. OBJECTIVE The problem of cancer health disparities is substantial. Clinical trials are widely advocated as a means of reducing disparities and bringing state-of-the-art care to the broader community, where most cancer care is delivered. This study sought to develop a better understanding of why disproportionately few African American men enroll in clinical trials given their substantial cancer burden. DESIGN This study applied community-based participatory research (CBPR) methods to design and conduct four focus groups of African American male cancer survivors and their caregivers in North Carolina. RESULTS Among major themes, participants expressed confusion about the relationship between clinical trials, treatment, and research: signifying patient confusion and misinterpretation of common clinical trial terminology. Social norms including gender barriers and generational differences remain problematic; participants often reported that men do not talk about health issues, are unwilling to go to the doctor, and exhibit misapprehension and distrust regarding trials. Participants perceived this misunderstanding as detrimental to community health and expressed the need for more clarity in clinical trials information and a more fundamental social openness and communication about cancer detection and treatment. CONCLUSION Findings indicate the importance of clinical trial education in both traditional provider referral to trials and also in general patient navigation. To dispel pervasive misapprehension regarding placebos, clinical trial information should emphasize the role of standard care in modern cancer treatment trials. Many participants described willingness to participate in a trial upon physician recommendation, suggesting merit in improving patient-physician communication through culturally competent terminology and trial referral systems.
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Affiliation(s)
- Laurel C Trantham
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William R Carpenter
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Lisa D DiMartino
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brandolyn White
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melissa Green
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Giselle Corbie-Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul A Godley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; Blue Cross and Blue Shield of North Carolina; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy. Support Care Cancer 2015; 23:1169-96. [PMID: 25591627 DOI: 10.1007/s00520-014-2581-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. METHODS An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. RESULTS In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. CONCLUSIONS Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.
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Jha T, Adhikari N, Halder AK, Saha A. Ligand- and Structure-Based Drug Design of Non-Steroidal Aromatase Inhibitors (NSAIs) in Breast Cancer. QUANTITATIVE STRUCTURE-ACTIVITY RELATIONSHIPS IN DRUG DESIGN, PREDICTIVE TOXICOLOGY, AND RISK ASSESSMENT 2015. [DOI: 10.4018/978-1-4666-8136-1.ch011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Aromatase is a multienzyme complex overexpressed in breast cancer and responsible for estrogen production. It is the potential target for designing anti-breast cancer drugs. Ligand and Structure-Based Drug Designing approaches (LBDD and SBDD) are involved in development of active and more specific Nonsteroidal Aromatase Inhibitors (NSAIs). Different LBDD and SBDD approaches are presented here to understand their utility in designing novel NSAIs. It is observed that molecules should possess a five or six membered heterocyclic nitrogen containing ring to coordinate with heme portion of aromatase for inhibition. Moreover, one or two hydrogen bond acceptor features, hydrophobicity, and steric factors may play crucial roles for anti-aromatase activity. Electrostatic, van der Waals, and p-p interactions are other important factors that determine binding affinity of inhibitors. HQSAR, LDA-QSAR, GQSAR, CoMFA, and CoMSIA approaches, pharmacophore mapping followed by virtual screening, docking, and dynamic simulation may be effective approaches for designing new potent anti-aromatase molecules.
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Loh SY, Lee SY, Quek KF, Murray L. Barriers to participation in a randomized controlled trial of Qigong exercises amongst cancer survivors: lessons learnt. Asian Pac J Cancer Prev 2014; 13:6337-42. [PMID: 23464455 DOI: 10.7314/apjcp.2012.13.12.6337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials on cancer subjects have one of the highest dropout rates. Barriers to recruitment range from patient-related, through institutional-related to staff-related factors. This paper highlights the low response rate and the recruitment barriers faced in our Qigong exercises trial. MATERIALS AND METHOD The Qigong trial is a three-arm trial with a priori power size of 114 patients for 80% power. The University Malaya Medical Centre database showed a total of 1,933 patients from 2006-2010 and 751 patients met our inclusion criteria. These patients were approached via telephone interview. 131 out of 197 patients attended the trial and the final response rate was 48% (n=95/197). RESULTS Multiple barriers were identified, and were regrouped as patient- related, clinician-related and/or institutional related. A major consistent barrier was logistic difficulty related to transportation and car parking at the Medical Centre. conclusions: All clinical trials must pay considerable attention to the recruitment process and it should even be piloted to identify potential barriers and facilitators to reduce attrition rate in trials.
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Affiliation(s)
- Siew Yim Loh
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Gerber DE, Laccetti AL, Xuan L, Halm EA, Pruitt SL. Impact of prior cancer on eligibility for lung cancer clinical trials. J Natl Cancer Inst 2014; 106:dju302. [PMID: 25253615 DOI: 10.1093/jnci/dju302] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In oncology clinical trials, the assumption that a prior cancer diagnosis could interfere with study conduct or outcomes results in frequent exclusion of such patients. We determined the prevalence and characteristics of this practice in lung cancer clinical trials and estimated impact on trial accrual. METHODS We reviewed lung cancer clinical trials sponsored or endorsed by the Eastern Oncology Cooperative Group for exclusion criteria related to a prior cancer diagnosis. We estimated prevalence of prior primary cancer diagnoses among lung cancer patients using Surveillance Epidemiology and End Results (SEER)-Medicare linked data. We assessed the association between trial characteristics and prior cancer exclusion using chi-square analysis. All statistical tests were two-sided. RESULTS Fifty-one clinical trials (target enrollment 13072 patients) were included. Forty-one (80%) excluded patients with a prior cancer diagnosis as follows: any prior (14%), within five years (43%), within two or three years (7%), or active cancer (16%). In SEER-Medicare data (n = 210509), 56% of prior cancers were diagnosed within five years before the lung cancer diagnosis. Across trials, the estimated number and proportion of patients excluded because of prior cancer ranged from 0-207 and 0%-18%. Prior cancer was excluded in 94% of trials with survival primary endpoints and 73% of trials with nonsurvival primary endpoints (P = .06). CONCLUSIONS A substantial proportion of patients are reflexively excluded from lung cancer clinical trials because of prior cancer. This inclusion criterion is applied widely across studies, including more than two-thirds of trials with nonsurvival endpoints. More research is needed to understand the basis and ramifications of this exclusion policy.
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Affiliation(s)
- David E Gerber
- Harold C. Simmons Cancer Center (DEG, EAH, SLP), Department of Internal Medicine (DEG, ALL, EAH), and Department of Clinical Sciences (LX, EAH, SLP), University of Texas Southwestern Medical Center, Dallas, TX.
| | - Andrew L Laccetti
- Harold C. Simmons Cancer Center (DEG, EAH, SLP), Department of Internal Medicine (DEG, ALL, EAH), and Department of Clinical Sciences (LX, EAH, SLP), University of Texas Southwestern Medical Center, Dallas, TX
| | - Lei Xuan
- Harold C. Simmons Cancer Center (DEG, EAH, SLP), Department of Internal Medicine (DEG, ALL, EAH), and Department of Clinical Sciences (LX, EAH, SLP), University of Texas Southwestern Medical Center, Dallas, TX
| | - Ethan A Halm
- Harold C. Simmons Cancer Center (DEG, EAH, SLP), Department of Internal Medicine (DEG, ALL, EAH), and Department of Clinical Sciences (LX, EAH, SLP), University of Texas Southwestern Medical Center, Dallas, TX
| | - Sandi L Pruitt
- Harold C. Simmons Cancer Center (DEG, EAH, SLP), Department of Internal Medicine (DEG, ALL, EAH), and Department of Clinical Sciences (LX, EAH, SLP), University of Texas Southwestern Medical Center, Dallas, TX
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Ohsumi S, Mukai H, Ohashi Y. Factors Affecting Enrollment in a Randomized Controlled Trial for Japanese Metastatic Breast Cancer Patients (SELECT BC-FEEL)--A Prospective Study. Jpn J Clin Oncol 2014; 44:696-701. [DOI: 10.1093/jjco/hyu065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Manne S, Kashy D, Albrecht T, Wong YN, Lederman Flamm A, Benson AB, Miller SM, Fleisher L, Buzaglo J, Roach N, Katz M, Ross E, Collins M, Poole D, Raivitch S, Miller DM, Kinzy TG, Liu T, Meropol NJ. Attitudinal barriers to participation in oncology clinical trials: factor analysis and correlates of barriers. Eur J Cancer Care (Engl) 2014; 24:28-38. [PMID: 24467411 PMCID: PMC4417937 DOI: 10.1111/ecc.12180] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
Patient participation in cancer clinical trials is low. Little is known about attitudinal barriers to participation, particularly among patients who may be offered a trial during an imminent initial oncology consult. The aims of the present study were to confirm the presence of proposed subscales of a recently developed cancer clinical trial attitudinal barriers measure, describe the most common cancer clinical trials attitudinal barriers, and evaluate socio-demographic, medical and financial factors associated with attitudinal barriers. A total of 1256 patients completed a survey assessing demographic factors, perceived financial burden, prior trial participation and attitudinal barriers to clinical trials participation. Results of a factor analysis did not confirm the presence of the proposed four attitudinal barriers subscale/factors. Rather, a single factor represented the best fit to the data. The most highly-rated barriers were fear of side-effects, worry about health insurance and efficacy concerns. Results suggested that less educated patients, patients with non-metastatic disease, patients with no previous oncology clinical trial participation, and patients reporting greater perceived financial burden from cancer care were associated with higher barriers. These patients may need extra attention in terms of decisional support. Overall, patients with fewer personal resources (education, financial issues) report more attitudinal barriers and should be targeted for additional decisional support.
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Affiliation(s)
- S Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Brown RF, Cadet DL, Houlihan RH, Thomson MD, Pratt EC, Sullivan A, Siminoff LA. Perceptions of participation in a phase I, II, or III clinical trial among African American patients with cancer: what do refusers say? J Oncol Pract 2013; 9:287-93. [PMID: 24130251 PMCID: PMC4853887 DOI: 10.1200/jop.2013.001039] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Less than 5% of all adult patients with cancer enter clinical trials. These rates are lower in racial/ethnic minority populations, negatively affecting the generalizability and validity of trial results. Many studies have identified barriers to minority enrolment, yet few have gathered in-depth insights into minority patients' reasons for trial refusal. We aimed to (1) explore trial refusal reasons in a sample of African American (AA) patients with cancer who declined trial participation and (2) gather patients' perceptions of the potential benefit of an array of decision support tools. METHODS Participants were 22 consecutively recruited AA patients with cancer who had declined participation in a therapeutic clinical trial. Within 3 months of the trial refusal decision, participants completed an audio-recorded semistructured interview that asked about demographic and disease information, psychosocial factors, and patients' experience with clinical trials. Two months later, participants completed a questionnaire that asked about their trial decision. RESULTS Few patients received positive recommendations about joining a trial. Patients gave multiple refusal reasons. Only two participants refused to join a clinical trial as a result of issues of mistrust. Most participants refused as a result of fears of additional burdens and adverse effects. Many patients and family members misunderstood trial information. Family members mostly recommended against trial participation. Most patients felt that question prompt lists or decision aids would assist information seeking and decision making. CONCLUSION Low rates of physician recommendations for clinical trial participation of AA patients with cancer warrant further investigation. Interventions to reduce misunderstandings and aid decision making, both within and external to the clinical interaction, need to target both patients and family members.
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Affiliation(s)
- Richard F. Brown
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Debbie L. Cadet
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Robert H. Houlihan
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Maria D. Thomson
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Emily C. Pratt
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Amy Sullivan
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
| | - Laura A. Siminoff
- Virginia Commonwealth University School of Medicine; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA
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Seah DS, Scott SM, Najita J, Openshaw T, Krag K, Frank E, Sohl J, Stadler ZK, Garrett M, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Attitudes of patients with metastatic breast cancer toward research biopsies. Ann Oncol 2013; 24:1853-1859. [PMID: 23493137 DOI: 10.1093/annonc/mdt067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Research studies involving human tissue are increasingly common. However, patients' attitudes toward research biopsies are not well characterized, particularly when the biopsies are carried out outside the context of therapeutic trials. PATIENTS AND METHODS One hundred sixty patients with metastatic breast cancer (MBC) from two academic (n = 80) and two community (n = 80) hospitals completed a 29-item self-administered survey to evaluate their willingness to consider providing research purposes only biopsies (RPOBs) (as a stand-alone procedure) and additional biopsies (ABs) (additional needle passes at the time of a clinically indicated biopsy). RESULTS Eighty-two (51%) of 160 patients would consider having RPOBs, of which 42 (53%) and 40 (50%) patients were from academic and community hospitals, respectively. Patients who had more prior biopsies were less likely to consider RPOBs (RR = 0.6, 95% CI: 0.4-1.0, P = 0.03). Of 160 patients, 115 (72%) patients would consider having ABs. Of these, 64 (80%) and 51 (64%) patients from academic and community hospitals, respectively, would consider ABs (RR = 1.2, 95% CI: 1.0-1.5, P = 0.03). CONCLUSIONS Many patients with MBC in both academic and community settings report willingness to consider undergoing biopsies for research. Further research is needed to understand ethical, logistical and provider-based barriers to broader participation in such studies.
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Affiliation(s)
- D S Seah
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - J Najita
- Department of Biostatics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - T Openshaw
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - K Krag
- Department of Medical Oncology, North Short Cancer Center, Danvers
| | - E Frank
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Sohl
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Z K Stadler
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - M Garrett
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - S G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston
| | - J Peppercorn
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E P Winer
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - Nancy U Lin
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston.
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Cameron P, Pond GR, Xu RY, Ellis PM, Goffin JR. A comparison of patient knowledge of clinical trials and trialist priorities. ACTA ACUST UNITED AC 2013; 20:e193-205. [PMID: 23737689 DOI: 10.3747/co.20.1323] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recruitment to clinical trials remains poor, and patient knowledge of clinical trials is one barrier to recruitment. To identify knowledge deficits, we conducted and compared surveys measuring actual patient knowledge and clinical trialist priorities for patient knowledge. METHODS Consenting patients at a tertiary cancer centre answered a survey that included 2 opinion questions about their own knowledge and willingness to join a trial, and22 knowledge questions. Clinical researchers at the centre were asked 13 questions about the importance of various trials factors. RESULTS Of 126 patients surveyed, 16% had joined a clinical trial, and 42% had a secondary school education or less. The mean correct response rate on the knowledge questions was 58%. Higher rates of correct responses were associated with lower age (p = 0.05), greater education (p = 0.006), prior trial participation (p < 0.001), agreement or strong agreement with perceived understanding of trials (p < 0.001), and willingness to join a clinical trial (p = 0.002). Trialists valued an understanding of the rationale for clinical trials and of randomization, placebo, and patient protection, but those particular topics were poorly understood by patients. CONCLUSIONS Patient knowledge about clinical trials is poor, including knowledge of several concepts ranked important by clinical trialists. The findings suggest that when developing education interventions, emphasis should be placed on the topics most directly related to patient care, and factors such as age and education level should be considered.
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Affiliation(s)
- P Cameron
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON. ; Present affiliation: Faculty of Health Sciences, Queen's University, Kingston, ON
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Chappuy H, Bouazza N, Minard-Colin V, Patte C, Brugières L, Landman-Parker J, Auvrignon A, Davous D, Pacquement H, Orbach D, Tréluyer JM, Doz F. Parental comprehension of the benefits/risks of first-line randomised clinical trials in children with solid tumours: a two-stage cross-sectional interview study. BMJ Open 2013; 3:bmjopen-2013-002733. [PMID: 23793670 PMCID: PMC3657641 DOI: 10.1136/bmjopen-2013-002733] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To analyse the parental understanding of informed consent information in first-line randomised clinical trials (RCTs) including children with malignant solid tumours and to assess parents' needs for decision-making. DESIGN Observational prospective study. SETTING 3 paediatric oncology centres in the Parisian region in France. PARTICIPANTS 53 parents were approached to participate in a RCT for their child with malignant solid tumour, over a 1-year period. 40 parents have been interviewed in our study. PRIMARY AND SECONDARY OUTCOME MEASURES Parental understanding of information in RCTs, parents' needs for decision-making. Parents were questioned by a psychologist, independent of the paediatric oncology teams, using a semidirected interview, 1 (M1) and 6 months (M6) after the consent was sought. RESULTS 18 parents (45%) did not understand the concept of randomisation. Half of the parents could explain neither the aim of the clinical trial nor the potential benefit to their child of inclusion. 35 parents (87.5%) expressed very few specific risks related to the trial. Being mostly French-speaking (p=0.03) and the reading of the information sheet by the parents (p=0.0025) improved their understanding. The parental comprehension did not differ between M1 and M6. The principal factors underlying their decision were confidence in the medical team (39%), wish to access to the best treatment (37%) and the best quality of life (37%). CONCLUSIONS Despite medical explanations, parents have limited knowledge in some areas in first-line RCTs and improvements of information process are required. The risks specific to the randomised trial are underestimated by parents and the unproven nature of the treatment is not well-known or understood.
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Affiliation(s)
- Hélène Chappuy
- Pediatric Emergency Department, Hôpital Necker Enfants Malades, Université Paris descartes, Paris, France
| | - Naim Bouazza
- Clinical Research Unit Paris centre, APHP, Paris, France
| | | | - Catherine Patte
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Paris, France
| | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Paris, France
| | | | - Anne Auvrignon
- Departement of Pediatric Oncology, Hôpital Armand Trousseau, Paris, France
| | - Dominique Davous
- Association Apprivoiser l'absence, Cent pour Sang la Vie, Paris, France
| | | | - Daniel Orbach
- Department of Pediatric Oncology, Institut Curie, Paris, France
| | | | - François Doz
- Department of Pediatric Oncology, Institut Curie, Paris, France
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Unger JM, Hershman DL, Albain KS, Moinpour CM, Petersen JA, Burg K, Crowley JJ. Patient income level and cancer clinical trial participation. J Clin Oncol 2013. [PMID: 23295802 DOI: 10.1200/jco.2012.45.4553.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation. PATIENTS AND METHODS We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost. RESULTS From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001). CONCLUSION Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels.
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Affiliation(s)
- Joseph M Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave, Seattle, WA 98109, USA.
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Unger JM, Hershman DL, Albain KS, Moinpour CM, Petersen JA, Burg K, Crowley JJ. Patient income level and cancer clinical trial participation. J Clin Oncol 2013; 31:536-42. [PMID: 23295802 DOI: 10.1200/jco.2012.45.4553] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation. PATIENTS AND METHODS We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost. RESULTS From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001). CONCLUSION Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels.
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Affiliation(s)
- Joseph M Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave, Seattle, WA 98109, USA.
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Penberthy L, Brown R, Wilson-Genderson M, Dahman B, Ginder G, Siminoff LA. Barriers to therapeutic clinical trials enrollment: differences between African-American and white cancer patients identified at the time of eligibility assessment. Clin Trials 2012; 9:788-97. [PMID: 23033547 DOI: 10.1177/1740774512458992] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials (CTs) are the mechanism by which research is translated into standards of care. Low recruitment among underserved and minority populations may result in inequity in access to the latest technology and treatments, compromise the generalizability, and lead to failure in identification of important positive or negative treatment effects among under-represented populations. METHODS Data were collected over a 39-month period on patient eligibility for available therapeutic cancer CTs. Reasons for ineligibility and refusal were collected. The data were captured using an automated software tool for tracking eligibility pre-enrollment. We examined characteristics associated with being evaluated for a trial, and reasons for ineligibility and refusal, overall and by patient race. RESULTS African-Americans (AAs) were more likely than Whites to be ineligible (odds ratio, (OR) = 1.26, 95% confidence interval (CI) = 1.0-1.58) and if eligible, to refuse participation (OR = 1.79, 95% CI = 1.27-2.52), even after adjusting for insurance, age, gender, study phase, and cancer type. White patients were more likely to be ineligible due to study-specific or cancer characteristics. AAs were more likely to be ineligible due to mental status or perceived noncompliance. Whites were more likely to refuse due to extra burden, due to concerns with randomization and toxicity, or because they express a positive treatment preference. AAs were more likely to refuse because they were not interested in CTs, because of family pressures, or they felt overwhelmed (NS)). DISCUSSION This study is the first to directly compare ineligibility and refusal rates and reasons captured prospectively in AA and White cancer patients. The data are consistent with earlier studies that indicated that AA patients more often are deemed ineligible and, when eligible, more often refuse participation. However, differences in reasons for ineligibility and refusal by race have implications for a cancer center to participate in CTs appropriate for the population of patients served. On a broader scale, consideration should be given to modifying eligibility criteria and other design aspects to permit broader participation of minority and other underserved groups.
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Affiliation(s)
- Lynne Penberthy
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, 23298-0306, USA.
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Shi X, Alford-Teaster J, Onega T, Wang D. Spatial Access and Local Demand for Major Cancer Care Facilities in the United States. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/00045608.2012.657498] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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75
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An MW, Mandrekar SJ, Sargent DJ. A 2-stage phase II design with direct assignment option in stage II for initial marker validation. Clin Cancer Res 2012; 18:4225-33. [PMID: 22700865 PMCID: PMC3421043 DOI: 10.1158/1078-0432.ccr-12-0686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biomarkers are critical to targeted therapies, as they may identify patients more likely to benefit from a treatment. Several prospective designs for biomarker-directed therapy have been previously proposed, differing primarily in the study population, randomization scheme, or both. Recognizing the need for randomization, yet acknowledging the possibility of promising but inconclusive results after a stage I cohort of randomized patients, we propose a 2-stage phase II design on marker-positive patients that allows for direct assignment in a stage II cohort. In stage I, marker-positive patients are equally randomized to receive experimental treatment or control. Stage II has the option to adopt "direct assignment" whereby all patients receive experimental treatment. Through simulation, we studied the power and type I error rate of our design compared with a balanced randomized two-stage design, and conducted sensitivity analyses to study the effect of timing of stage I analysis, population shift effects, and unbalanced randomization. Our proposed design has minimal loss in power (<1.8%) and increased type I error rate (<2.1%) compared with a balanced randomized design. The maximum increase in type I error rate in the presence of a population shift was between 3.1% and 5%, and the loss in power across possible timings of stage I analysis was less than 1.2%. Our proposed design has desirable statistical properties with potential appeal in practice. The direct assignment option, if adopted, provides for an "extended confirmation phase" as an alternative to stopping the trial early for evidence of efficacy in stage I.
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Affiliation(s)
- Ming-Wen An
- Department of Mathematics, Vassar College, Poughkeepsie, New York, NY, USA.
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76
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Wells KJ, Quinn GP, Meade CD, Fletcher M, Tyson DM, Jim H, Jacobsen PB. Development of a cancer clinical trials multi-media intervention: clinical trials: are they right for you? PATIENT EDUCATION AND COUNSELING 2012; 88:232-240. [PMID: 22525803 DOI: 10.1016/j.pec.2012.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 03/15/2012] [Accepted: 03/27/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe processes used to develop a multi-media psycho-educational intervention to prepare patients for a discussion about cancer clinical trials (CTs). METHODS Guided by a Steering Committee, formative research was conducted to develop an informative and engaging tool about cancer CTs. Twenty-three patients and caregivers participated in formative in-depth interviews to elicit information about perceptions of cancer CTs to inform production of a new media product. RESULTS Formative research revealed participants had concerns about experimentation, held beliefs that cancer CTs were for patients who had no other treatment options, and wanted a balance of information about pros and cons of CT participation. The value of physicians as credible spokespersons and the use of patients as role-models were supported. Using iterative processes, the production team infused the results into creation of a multimedia psycho-educational intervention titled Clinical Trials: Are they Right for You? CONCLUSION An intervention, developed through an iterative consumer-focused process involving multiple stakeholders and formative research, may result in an engaging informative product. PRACTICE IMPLICATIONS If found to be efficacious, Clinical Trials: Are they Right for You? is a low-cost and easily disseminated multimedia psycho-educational intervention to assist cancer patients with making an informed decision about cancer CTs.
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Affiliation(s)
- Kristen J Wells
- University of South Florida, College of Medicine, Tampa FL 33612, USA.
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77
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Parreco LK, DeJoice RW, Massett HA, Padberg RM, Thakkar SS. Power of an effective clinical conversation: improving accrual onto clinical trials. J Oncol Pract 2012; 8:282-6. [PMID: 23277764 DOI: 10.1200/jop.2011.000478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2011] [Indexed: 11/20/2022] Open
Abstract
The National Cancer Institute (NCI) is actively transforming clinical trials to revitalize the clinical trials system and improve patient accrual. For more than 30 years, NCI has provided information and communication resources about cancer clinical trials. The Institute supports a clinical trials Web site (www.cancer.gov/clinicaltrials) that receives nearly a half million page views a month. In addition, NCI's Cancer Information Service (800-4-CANCER, chat and e-mail) responds to 1,750 clinical trial inquiries every month. Although these numbers suggest that a high volume of clinical trial information is being exchanged between NCI, the public, and providers, most patients decide whether to participate in clinical trials during the patient-provider interaction.
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78
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Miller SM, Hudson SV, Egleston BL, Manne S, Buzaglo JS, Devarajan K, Fleisher L, Millard J, Solarino N, Trinastic J, Meropol NJ. The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial. Psychooncology 2012; 22:481-9. [PMID: 22331643 DOI: 10.1002/pon.3043] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/04/2012] [Accepted: 01/14/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patient's decision to participate. Little is known about the relationship among knowledge, self-efficacy, preparation, decisional conflict, and patient decisions to take part in CCTs. OBJECTIVE The purpose of this study was to determine if preparation for consideration of a CCT as a treatment option mediates the relationship between knowledge, self-efficacy, and decisional conflict. We also explored whether lower levels of decisional conflict are associated with greater likelihood of CCT enrollment. METHOD In a pre-post test intervention study, cancer patients (N = 105) were recruited before their initial consultation with a medical oncologist. A brief educational intervention was provided for all patients. Patient self-report survey responses assessed knowledge, self-efficacy, preparation for clinical trial participation, decisional conflict, and clinical trial participation. RESULTS Preparation was found to mediate the relationship between self-efficacy and decisional conflict (p = 0.003 for a test of the indirect mediational pathway for the decisional conflict total score). Preparation had a more limited role in mediating the effect of knowledge on decisional conflict. Further, preliminary evidence indicated that reduced decisional conflict was associated with increased clinical trial enrollment (p = 0.049). CONCLUSIONS When patients feel greater CCT self-efficacy and have more knowledge, they feel more prepared to make a CCT decision. Reduced decisional conflict, in turn, is associated with the decision to enroll in a clinical trial. Our results suggest that preparation for decision-making should be a target of future interventions to improve participation in CCTs.
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Affiliation(s)
- S M Miller
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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79
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Abstract
Innovative projects to reduce disparities in cancer treatment and research include partnerships between academic and community cancer centers, patient navigation programs and strategies to promote community awareness, education and engagement. A 4 h training program about cancer clinical trials was developed through a needs assessment and in collaboration with community health workers who served as consultants and a larger advisory board comprised of community health workers, educators and clinical trialists. This program was delivered first as a collaboration between a phsycian who is experienced in the conduct of clinical research and two community health workers, and subsequently by the community health workers alone. We report on four workshops attended by a total of 61 community health workers recruited from Boston-area hospitals, community health centers and outreach programs. Support for and knowledge of clinical trials was measured in a pretest and post-test, which also included a satisfaction rating. Participants had a range of prior experience with clinical trials in the context of their personal and professional experience. Mean accuracy of knowledge about clinical trials increased from 72 to 84%, support for clinical trials improved considerably, and satisfaction with the training experience was high. Knowledge gaps and low levels of support for cancer clinical trials among community health workers can be improved with a short training program delivered by other community health workers. Further research is needed to identify the impact of this training on accrual to cancer clinical trials.
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80
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Biedrzycki BA. Research information knowledge, perceived adequacy, and understanding in cancer clinical trial participants. Oncol Nurs Forum 2011; 38:E291-6. [PMID: 21708524 DOI: 10.1188/11.onf.e291-e296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the adequacy of research information among people with cancer at the time they accept or decline participation in a cancer clinical trial. DESIGN Cross-sectional, descriptive. SETTING An urban, academic, National Cancer Institute-designated comprehensive cancer center. SAMPLE 197 patients with advanced gastrointestinal cancer. METHODS Mailed survey; self-reported data. MAIN RESEARCH VARIABLES Adequacy of research information (actual knowledge, perceived adequacy of information, and perceived understanding), cancer clinical trial participation, and satisfaction with the decision to participate. FINDINGS Most respondents (88%) perceived themselves as having adequate information to make an informed decision regarding cancer clinical trial participation. In addition, 35% demonstrated adequate knowledge of basic clinical research. CONCLUSIONS Patients decide to accept or decline cancer clinical trials without having adequate knowledge. IMPLICATIONS FOR NURSING Nurses have an important role in educating patients regarding cancer clinical trials. The ideal teachable moment may not occur at the time of diagnosis; other less stressful opportunities may present when the patient is more receptive.
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Affiliation(s)
- Barbara A Biedrzycki
- Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD, USA.
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81
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Biedrzycki BA. Factors and Outcomes of Decision Making for Cancer Clinical Trial Participation. Oncol Nurs Forum 2011; 38:542-52. [DOI: 10.1188/11.onf.542-552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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82
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Bell J, Ho A. Authenticity as a necessary condition for voluntary choice: a case study in cancer clinical trial participation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2011; 11:33-35. [PMID: 21806437 DOI: 10.1080/15265161.2011.583330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jennifer Bell
- University of British Columbia, Vancouver, British Columbia V6T 1Z2, Canada.
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83
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Comis RL, Miller JD, Colaizzi DD, Kimmel LG. Physician-related factors involved in patient decisions to enroll onto cancer clinical trials. J Oncol Pract 2011; 5:50-6. [PMID: 20856718 DOI: 10.1200/jop.0922001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The development of new cancer therapies requires additional, and more complex, clinical trials. But only approximately 3% to 5% of adult cancer patients participate in cancer clinical trials. This study seeks to identify and understand the attitudes of the public and cancer survivors toward health-related decisions and cancer clinical trials to identify the key factors that must be addressed to increase that percentage.
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Affiliation(s)
- Robert L Comis
- Coalition of Cancer Cooperative Groups, Philadelphia, PA; and Michigan State University, East Lansing, MI
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84
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Brown RF, Shuk E, Butow P, Edgerson S, Tattersall MHN, Ostroff JS. Identifying patient information needs about cancer clinical trials using a Question Prompt List. PATIENT EDUCATION AND COUNSELING 2011; 84:69-77. [PMID: 20675095 PMCID: PMC2978253 DOI: 10.1016/j.pec.2010.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/17/2010] [Accepted: 07/03/2010] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Question Prompt Lists (QPLs) have demonstrated significant promise in facilitating communication in general, surgical and palliative oncology settings yet have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for Clinical Trials (QPL-CT). METHODS Breast, lung, and genitourinary cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial joined focus groups to help develop and explore the acceptability of a QPL-CT. Clinicians also participated in separated focus groups. Focus groups were audio-recorded and transcribed. We explored patients' trial information needs and views about the utility of the QPL-CT. RESULTS Patients focused on four trial information needs: understanding foundational information, conflict of interest issues and financial implications of trial participation. Of note, experienced patients need to personalize foundational information. CONCLUSION Patient information needs varied considerably and were influenced by trial experience. Patients valued the QPL-CT as an aid to gathering new trial information and ensuring that their information needs were met. PRACTICE IMPLICATIONS Physicians need to carefully elicit patient information needs and tailor trial information to meet these needs. The QPL-CT, may be of great benefit during clinical trial discussions.
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Affiliation(s)
- Richard F Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298-0149, USA.
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85
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Onega T, Cook A, Kirlin B, Shi X, Alford-Teaster J, Tuzzio L, Buist DSM. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat 2011; 129:269-75. [PMID: 21553117 DOI: 10.1007/s10549-011-1549-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.
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Affiliation(s)
- Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA.
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86
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Stepan KA, Gonzalez AP, Dorsey VS, Frye DK, Pyle ND, Smith RF, Throckmorton TA, Villejo LA, Cantor SB. Recommendations for enhancing clinical trials education: a review of the literature. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:64-71. [PMID: 20862574 DOI: 10.1007/s13187-010-0160-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study aims to apply the evidence-based practice (EBP) process to determine the factors that influence patients' understanding of, participation in, and satisfaction with clinical trials, the informed consent process, and treatment decisions and to make recommendations for improving clinical trials education. Beginning with evidence retrieval, the authors identified key search terms and searched MEDLINE--Ovid, MEDLINE--PubMed, and the Cumulative Index to Nursing and Allied Health Literature to identify articles published between July 2001 and July 2006 that highlighted clinical trials education. The articles were reviewed for clinical trials patient education information, clinician methods of communicating clinical trial information to patients, and patient satisfaction with the clinical trials process, including the informed consent process. As a result, practice changes were recommended for the patient/family, staff/community, and institution. From the literature review, 81 articles were identified. Recurring themes included decision-making, patient education, staff education, and pediatrics. Most articles focused on methods and strategies aimed at improving education at the patient/family, staff/community, and institutional levels. The issues surrounding clinical trial education are complex due to multiple variables interfering with poor patient understanding of, participation in, and satisfaction with clinical trial treatment decisions. On the basis of our findings, we recommend that clinicians involved in educating patients, families, staff, and communities about clinical trials have an awareness of and understanding for very complex issues.
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Affiliation(s)
- Karen A Stepan
- Patient Education Office, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 21, Houston, TX 77030, USA.
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87
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Community health workers' support for cancer clinical trials: description and explanation. J Community Health 2010; 35:417-22. [PMID: 20352478 DOI: 10.1007/s10900-010-9267-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ethnic differences in participation in cancer clinical trials slow advances in medical knowledge that can reduce health care disparities. Community health workers (CHWs) are an increasingly important bridge between the health care system and underserved communities and could play an important role in increasing rates of clinical trial participation. We investigated community health workers' orientations to medical research and cancer clinical trials with a mixed methods design: two focus groups, 11 intensive interviews, and a structured survey of 76 CHW training workshop participants. CHWs demonstrated high levels of commitment to improving the health of community members but considerable distrust of researchers' motives, low levels of knowledge about cancer clinical trials, and frequent perceptions of bias in the health care system. Support for research is associated with more research experience, self-assessed knowledge, and Hispanic ethnicity, but with less seniority as a CHW. Neither actual knowledge of cancer clinical trials nor perceptions of bias in the health care system were related to degree of support for medical research. Community health workers perceive bias in the health care system but recognize the importance of medical research and are interested in learning more about cancer clinical trials. Research experience increases support for medical research; education increases perceptions of health care system bias.
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88
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Cofield SS, Conwit R, Barsan W, Quinn J. Recruitment and retention of patients into emergency medicine clinical trials. Acad Emerg Med 2010; 17:1104-12. [PMID: 21040112 PMCID: PMC3058592 DOI: 10.1111/j.1553-2712.2010.00866.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The emergency medicine (EM) and prehospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in EM clinical trials and provides strategies from EM and non-EM trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in EM clinical trials.
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Affiliation(s)
- Stacey S Cofield
- Department of Biostatistics, The University of Alabama at Birmingham, USA
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89
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Stepan KA, Gonzalez AP, Pyle ND, Villejo LA, Cantor SB. Initiative to standardize a clinical trial educational program. Oncol Nurs Forum 2010; 37:535-9. [PMID: 20797946 DOI: 10.1188/10.onf.535-539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Karen A Stepan
- Anderson Cancer Center, University of Texas, Houston, MD, USA. kstepan@mdanderson
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90
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Enhancing decision making about participation in cancer clinical trials: development of a question prompt list. Support Care Cancer 2010; 19:1227-38. [PMID: 20593202 DOI: 10.1007/s00520-010-0942-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 06/14/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician-patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). METHOD Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients' decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. RESULTS Decision making was influenced by the outcome of patients' comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors' recommendation about the trial. Severity of a patient's disease influenced trial decision making only for trial-naive patients. CONCLUSION Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion.
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91
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Yang ZJ, McComas K, Gay G, Leonard JP, Dannenberg AJ, Dillon H. Motivation for health information seeking and processing about clinical trial enrollment. HEALTH COMMUNICATION 2010; 25:423-36. [PMID: 20677046 DOI: 10.1080/10410236.2010.483338] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Low patient accrual in clinical trials poses serious concerns for the advancement of medical science in the United States. Past research has identified health communication as a crucial step in overcoming barriers to enrollment. However, few communication scholars have studied this problem from a sociopsychological perspective to understand what motivates people to look for or pay attention to information about clinical trial enrollment. This study applies the model of Risk Information Seeking and Processing (RISP) to this context of health decision making. By recognizing the uncertainties embedded in clinical trials, we view clinical trial enrollment as a case study of risk. With data from a random-digit-dial telephone survey of 500 adults living in the United States, we used structural equation modeling to test the central part of the RISP model. In particular, we examined the role of optimistic feelings, as a type of positive affect, in motivating information seeking and processing. Our results indicated that rather than exerting an indirect influence on information seeking through motivating a psychological need for more information, optimistic feelings have more direct relationships with information seeking and processing. Similarly, informational subjective norms also exhibit a more direct relationship with information seeking and processing. These results suggest merit in applying the RISP model to study health decision making related to clinical trial enrollment. Our findings also render practical implications on how to improve communication about clinical trial enrollment.
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Affiliation(s)
- Z Janet Yang
- Department of Communication, University at Buffalo, State University of New York, College of Arts & Sciences, Buffalo, NY 14260, USA.
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92
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Shah JY, Phadtare A, Rajgor D, Vaghasia M, Pradhan S, Zelko H, Pietrobon R. What leads Indians to participate in clinical trials? A meta-analysis of qualitative studies. PLoS One 2010; 5:e10730. [PMID: 20505754 PMCID: PMC2873955 DOI: 10.1371/journal.pone.0010730] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 04/05/2010] [Indexed: 11/19/2022] Open
Abstract
Background With the globalization of clinical trials, large developing nations have substantially increased their participation in multi-site studies. This participation has raised ethical concerns, among them the fear that local customs, habits and culture are not respected while asking potential participants to take part in study. This knowledge gap is particularly noticeable among Indian subjects, since despite the large number of participants, little is known regarding what factors affect their willingness to participate in clinical trials. Methods We conducted a meta-analysis of all studies evaluating the factors and barriers, from the perspective of potential Indian participants, contributing to their participation in clinical trials. We searched both international as well as Indian-specific bibliographic databases, including Pubmed, Cochrane, Openjgate, MedInd, Scirus and Medknow, also performing hand searches and communicating with authors to obtain additional references. We enrolled studies dealing exclusively with the participation of Indians in clinical trials. Data extraction was conducted by three researchers, with disagreement being resolved by consensus. Results Six qualitative studies and one survey were found evaluating the main themes affecting the participation of Indian subjects. Themes included Personal health benefits, Altruism, Trust in physicians, Source of extra income, Detailed knowledge, Methods for motivating participants as factors favoring, while Mistrust on trial organizations, Concerns about efficacy and safety of trials, Psychological reasons, Trial burden, Loss of confidentiality, Dependency issues, Language as the barriers. Conclusion We identified factors that facilitated and barriers that have negative implications on trial participation decisions in Indian subjects. Due consideration and weightage should be assigned to these factors while planning future trials in India.
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Affiliation(s)
- Jatin Y. Shah
- Graduate Medical School, Duke-National University of Singapore, Singapore, Singapore
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
| | - Amruta Phadtare
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
- Kalpavriksha Healthcare and Research, Thane, India
| | - Dimple Rajgor
- Graduate Medical School, Duke-National University of Singapore, Singapore, Singapore
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
| | - Meenakshi Vaghasia
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
- Kalpavriksha Healthcare and Research, Thane, India
| | - Shreyasee Pradhan
- Graduate Medical School, Duke-National University of Singapore, Singapore, Singapore
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
| | - Hilary Zelko
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University, Durham, North Carolina, United States of America
| | - Ricardo Pietrobon
- Graduate Medical School, Duke-National University of Singapore, Singapore, Singapore
- Research on Research Group, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Janet Yang Z, McComas K, Gay G, Leonard JP, Dannenberg AJ, Dillon H. From information processing to behavioral intentions: exploring cancer patients' motivations for clinical trial enrollment. PATIENT EDUCATION AND COUNSELING 2010; 79:231-238. [PMID: 19748204 DOI: 10.1016/j.pec.2009.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/29/2009] [Accepted: 08/12/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate cancer patients' motivations for clinical trial enrollment, this study tests the proposition that a model of Risk Information Seeking and Processing (RISP) could serve as an antecedent to the Theory of Planned Behavior (TPB). METHODS With data from a telephone survey, we examined whether components of the RISP model had significant impact on belief-based attitudes and behavioral intentions. RESULTS Risk judgment and affective responses, especially optimistic feelings, consistently related to attitudes and behavioral intentions. Trust in doctors also significantly related to our respondents' positive attitudes toward clinical trials. CONCLUSION The RISP model might have more constrained applicability as compared to the TPB in explaining cancer patients' motivations for clinical trial enrollment. However, certain components of the RISP model seemed to contribute to our respondents' attitude formation as interesting additions to the TPB. PRACTICE IMPLICATIONS Communication about clinical trials is a balance act between providing sufficient information about the potential risks and benefits involved in a clinical trial and managing emotional responses that cancer patients associate with participation. Both acts contribute to the formation of positive attitudes toward clinical trials among cancer patients, which is the driving force behind their intentions for clinical trial enrollment.
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Affiliation(s)
- Z Janet Yang
- Department of Communication, State University of New York at Buffalo, NY 14260, USA.
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94
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Brown R, Bylund CL, Siminoff LA, Slovin SF. Seeking informed consent to Phase I cancer clinical trials: identifying oncologists' communication strategies. Psychooncology 2010; 20:361-8. [PMID: 20878842 DOI: 10.1002/pon.1748] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/25/2010] [Accepted: 03/01/2010] [Indexed: 11/11/2022]
Abstract
PURPOSE Phase I clinical trials are the gateway to effective new cancer treatments. Many physicians have difficulty when discussing Phase I clinical trials. Research demonstrates evidence of suboptimal communication. Little is known about communication strategies used by oncologists when recruiting patients for Phase I trials. We analyzed audio recorded Phase I consultations to identify oncologists' communication strategies. PATIENTS AND METHODS Subjects were consecutive cancer patients from six medical oncologists attending one of three outpatient clinics at a major Cancer Center in the United States. Sixteen patients signed informed consent for audio recording of their consultations in which a Phase I study was discussed. These were transcribed in full and analyzed to identify communication strategies. RESULTS Six communication themes emerged from the analysis: (1) orienting, (2) educating patients, (3) describing uncertainty and prognosis, (4) persuading, (5) decision making, and (6) making a treatment recommendation. As expected, although there was some common ground between communication in Phase I and the Phase II and III settings, there were distinct differences. CONCLUSIONS Oncologists used persuasive communication, made explicit recommendations, or implicitly expressed a treatment preference and were choice limiting. This highlights the complexity of discussing Phase I trials and the need to develop strategies to aid oncologists and patients in these difficult conversations. Patient centered communication that values patient preferences while preserving the oncologist's agenda can be a helpful approach to these discussions.
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Affiliation(s)
- Richard Brown
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0581, USA.
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95
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Penberthy L, Brown R, Puma F, Dahman B. Automated matching software for clinical trials eligibility: measuring efficiency and flexibility. Contemp Clin Trials 2010; 31:207-17. [PMID: 20230913 DOI: 10.1016/j.cct.2010.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 03/03/2010] [Accepted: 03/08/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical trials (CT) serve as the media that translates clinical research into standards of care. Low or slow recruitment leads to delays in delivery of new therapies to the public. Determination of eligibility in all patients is one of the most important factors to assure unbiased results from the clinical trials process and represents the first step in addressing the issue of under representation and equal access to clinical trials. METHODS This is a pilot project evaluating the efficiency, flexibility, and generalizibility of an automated clinical trials eligibility screening tool across 5 different clinical trials and clinical trial scenarios. RESULTS There was a substantial total savings during the study period in research staff time spent in evaluating patients for eligibility ranging from 165h to 1329h. There was a marked enhancement in efficiency with the automated system for all but one study in the pilot. The ratio of mean staff time required per eligible patient identified ranged from 0.8 to 19.4 for the manual versus the automated process. CONCLUSION The results of this study demonstrate that automation offers an opportunity to reduce the burden of the manual processes required for CT eligibility screening and to assure that all patients have an opportunity to be evaluated for participation in clinical trials as appropriate. The automated process greatly reduces the time spent on eligibility screening compared with the traditional manual process by effectively transferring the load of the eligibility assessment process to the computer.
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Affiliation(s)
- Lynne Penberthy
- Dept of Internal Medicine, School of Medicine, Virginia Commonwealth University, Massey Cancer Center, United States.
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96
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Li JY, Yu CH, Jiang Y. Participation in Cancer Clinical Trials as Viewed by Chinese Patients and Their Families. Oncology 2010; 79:343-8. [DOI: 10.1159/000323325] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
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97
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Avis-Williams A, Khoury A, Lisovicz N, Graham-Kresge S. Knowledge, attitudes, and practices of underserved women in the rural South toward breast cancer prevention and detection. FAMILY & COMMUNITY HEALTH 2009; 32:238-246. [PMID: 19525705 DOI: 10.1097/fch.0b013e3181ab3bbb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers conducted 6 focus groups to assess barriers of minority women in Mississippi toward breast cancer prevention and clinical trials. These women had little knowledge of treatment options and negative perceptions of screening and clinical trial participation. This research equips others to identify new health education strategies. Conclusions also provide insight into prevention for other minority populations, such as Latina, Asian, and American Indian women.
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98
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Murray P, Kerridge I, Tiley C, Catanzariti A, Welberry H, Lean C, Sinclair S, Bishop J, Bradstock K. Enrolment of patients to clinical trials in haematological cancer in New South Wales: current status, perceived barriers and opportunities for improvement. Intern Med J 2009; 40:133-8. [DOI: 10.1111/j.1445-5994.2009.01911.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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99
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Biasoli I, Franchi-Rezgui P, Sibon D, Brière J, de Kerviler E, Thieblemont C, Levy V, Gisselbrecht C, Brice P. Analysis of factors influencing inclusion of 102 patients with stage III/IV Hodgkin's lymphoma in a randomized trial for first-line chemotherapy. Ann Oncol 2008; 19:1915-20. [DOI: 10.1093/annonc/mdn391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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100
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Paskett ED, Reeves KW, McLaughlin JM, Katz ML, McAlearney AS, Ruffin MT, Halbert CH, Merete C, Davis F, Gehlert S. Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience. Contemp Clin Trials 2008; 29:847-61. [PMID: 18721901 PMCID: PMC2642621 DOI: 10.1016/j.cct.2008.07.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 07/22/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The recruitment of minority and underserved individuals to research studies is often problematic. The purpose of this study was to describe the recruitment experiences of projects that actively recruited minority and underserved populations as part of The Centers for Population Health and Health Disparities (CPHHD) initiative. METHODS Principal investigators and research staff from 17 research projects at eight institutions across the United States were surveyed about their recruitment experiences. Investigators reported the study purpose and design, recruitment methods employed, recruitment progress, problems or challenges to recruitment, strategies used to address these problems, and difficulties resulting from Institutional Review Board (IRB) or Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Additionally, information was collected about participant burden and compensation. Burden was classified on a three-level scale. Recruitment results were reported as of March 31, 2007. RESULTS Recruitment attainment ranged from 52% to 184% of the participant recruitment goals. Commonly reported recruitment problems included administrative issues, and difficulties with establishing community partnerships and contacting potential participants. Long study questionnaires, extended follow-up, and narrow eligibility criteria were also problematic. The majority of projects reported difficulties with IRB approvals, though few reported issues related to HIPAA requirements. Attempted solutions to recruitment problems varied across Centers and included using multiple recruitment sites and sources and culturally appropriate invitations to participate. Participant burden and compensation varied widely across the projects, however, accrual appeared to be inversely associated with the amount of participant burden for each project. CONCLUSION Recruitment of minority and underserved populations to clinical trials is necessary to increase study generalizbility and reduce health disparities. Our results demonstrate the importance of flexible study designs which allow adaptation to recruitment challenges. These experiences also highlight the importance of involving community members and reducing participant burden to achieve success in recruiting individuals from minority and underserved populations.
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Affiliation(s)
- Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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