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Soomro N, Lecouturier J, Stocken DD, Shen J, Hynes AM, Ainsworth HF, Breen D, Oades G, Rix D, Aitchison M. Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT. Health Technol Assess 2019; 21:1-68. [PMID: 29280434 DOI: 10.3310/hta21810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance. OBJECTIVES To explore the feasibility of a randomised trial of ablation versus active surveillance. DESIGN Two-stage feasibility study: stage 1 - clinician survey and co-design work; and stage 2 - randomised feasibility study with qualitative and economic components. METHODS Stage 1 - survey of radiologists and urologists, and development of patient information materials. Stage 2 - patients identified across eight UK centres with small renal tumours (< 4 cm) were randomised (1 : 1 ratio) to ablation or active surveillance in an unblinded manner. Randomisation was carried out by a central computer system. The primary objective was to determine willingness to participate and to randomise a target of 60 patients. The qualitative and economic data were collected separately. RESULTS The trial was conducted across eight centres, with a site-specific period of recruitment ranging from 3 to 11 months. Of the 154 patients screened, 36 were eligible and were provided with study details. Seven agreed to be randomised and one patient was found ineligible following biopsy results. Six patients (17% of those eligible) were randomised: three patients received ablation and no serious adverse events were recorded. The 3- and 6-month data were collected for four (67%) and three (50%) out of the six patients, respectively. The qualitative substudy identified factors directly impacting on the recruitment of this trial. These included patient and clinician preferences, organisational factors (variation in clinical pathway) and standard treatment not included. The health economic questionnaire was designed and piloted; however, the sample size of recruited patients was insufficient to draw a conclusion on the feasibility of the health economics. CONCLUSIONS The trial did not meet the criteria for progression and the recruitment rate was lower than hypothesised, demonstrating that a full trial is presently not possible. The qualitative study identified factors that led to variation in recruitment across the sites. Implementation of organisational and operational measures can increase recruitment in any future trial. There was insufficient information to conduct a full economic analysis. TRIAL REGISTRATION Current Controlled Trials ISRCTN31161700. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 81. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Naeem Soomro
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jing Shen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Holly F Ainsworth
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Breen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - David Rix
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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152
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Miyahira AK, Den RB, Carlo MI, de Leeuw R, Hope TA, Karzai F, McKay RR, Salami SS, Simons JW, Pienta KJ, Soule HR. Tumor cell heterogeneity and resistance; report from the 2018 Coffey-Holden Prostate Cancer Academy Meeting. Prostate 2019; 79:244-258. [PMID: 30381857 DOI: 10.1002/pros.23729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The 2018 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Tumor Cell Heterogeneity and Resistance," was held in Los Angeles, California from June 21 to 24, 2018. METHODS The CHPCA Meeting is a unique, discussion-oriented scientific conference convened annually by the Prostate Cancer Foundation (PCF), which focuses on the most critical topics in need of further study to advance the treatment of lethal prostate cancer. The 6th Annual CHPCA Meeting was attended by 70 investigators and concentrated on prostate cancer heterogeneity and treatment resistance. RESULTS The meeting focused on topics including: recognition of tumor heterogeneity, molecular drivers of heterogeneity, the role of the tumor microenvironment, the role of heterogeneity in disease progression, metastasis and treatment resistance, clinical trials designed to target resistance and tumor heterogeneity, and immunotherapeutic approaches to target and overcome tumor heterogeneity. DISCUSSION This review article summarizes the presentations and discussions from the 2018 CHPCA Meeting in order to share this knowledge with the scientific community and encourage new studies that will lead to improved treatments and outcomes for men with prostate cancer.
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Affiliation(s)
| | - Robert B Den
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maria I Carlo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Renée de Leeuw
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Fatima Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Rana R McKay
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California
| | - Simpa S Salami
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | | | - Kenneth J Pienta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Urology, The James Buchanan Brady Urological Institute, Baltimore, Maryland
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland
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153
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Sivaprasad S, Tschosik EA, Guymer RH, Kapre A, Suñer IJ, Joussen AM, Lanzetta P, Ferrara D. Living with Geographic Atrophy: An Ethnographic Study. Ophthalmol Ther 2019; 8:115-124. [PMID: 30706242 PMCID: PMC6393253 DOI: 10.1007/s40123-019-0160-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction The specific impact from the patient’s perspective of geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD), is not well understood. Methods An ethnographic study was conducted to understand the impact of bilateral GA secondary to AMD on daily functioning by observing regular activities performed at home and through semi-structured interviews. Eligible subjects had a definitive GA diagnosis, including presence of drusen, GA lesion size of at least one disc area in the better-seeing eye, and no other confounding ophthalmologic diagnosis. Data were collected via video recordings and field notes, and analyzed by coding video transcripts. Results Functional impact domains affecting more than two of the 16 subjects from the United Kingdom, United States, or Germany were activities of daily living (difficulty reading, n = 16; driving, n = 12; and watching movies, television, or theater, n = 11), emotional (frustration, and fear of blindness, n = 7 each), social/leisure (interference with hobbies, n = 8, and diminished social activities, n = 4), physical (n = 4), and financial (n = 10). Subjects with a best-corrected visual acuity (BCVA) of 20/100 or better in the better-seeing eye (n = 10) reported similar functional impacts to those with a BCVA of worse than 20/100 in their better-seeing eye (n = 5). Conclusion This study helps address gaps in patient-focused research into GA, which negatively impacts the day-to-day functioning of patients. Larger qualitative and quantitative studies are needed to quantify patient experiences and assess the correlation between BCVA score and impact of GA. Funding F. Hoffmann-La Roche Ltd.
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Affiliation(s)
| | - Elizabeth A Tschosik
- Department of Patient-Centered Outcomes Research, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA.
| | - Robyn H Guymer
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Audrey Kapre
- Department of Patient-Centered Outcomes Research, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Antonia M Joussen
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Daniela Ferrara
- Clinical Science Ophthalmology, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
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154
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Jeon JK, Kim JH. Perception and Satisfaction of Anticancer Drug Clinical Trials in Cancer Patients. ASIAN ONCOLOGY NURSING 2019. [DOI: 10.5388/aon.2019.19.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ju Kyung Jeon
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Hye Kim
- Department of Clinical Nursing, University of Ullsan, Seoul, Korea
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155
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Jurczak W, Długosz-Danecka M, Rivas Navarro F. The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions. Future Oncol 2019; 15:305-317. [DOI: 10.2217/fon-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.
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Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków 31-501, Poland
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156
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Crino ND, Parker HM, Gifford JA, Lau KYK, Greenfield EM, Donges CE, O'Dwyer NJ, Steinbeck KS, O'Connor HT. Recruiting young women to weight management programs: Barriers and enablers. Nutr Diet 2018; 76:392-398. [PMID: 30575276 DOI: 10.1111/1747-0080.12505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/25/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
AIM Recruiting young women to weight management research programs is difficult. The purpose of this study was to gain insights into the barriers and motivators that influence participation and to explore effective methods of recruitment from the perspective of young women with obesity living in both urban and regional areas. METHODS Semi-structured interviews were used to elicit information from focus groups. The interviews were transcribed, coded and analysed qualitatively. Eight focus groups, which included a total of 27 women, were conducted. Participants had a mean age of 29.1 (±5.1) years and a mean body mass index of 35.8 (±2.9) kg/m2 . RESULTS The barriers to participation were multifaceted and largely similar across urban and regional participants. Fear of judgement and uncertainty about the process were major psychosocial barriers. A lack of tailoring of program content was an important program-related barrier. Physical barriers such as time commitment, cost and access were discussed extensively, particularly in urban groups. The provision of incentives and the use of positive language that focusses on the benefits of the intervention were viewed positively. Physical and virtual methods of recruitment were identified as potentially effective provided they were presented in media that this group is likely to use and can access in a private location. CONCLUSIONS The results of this study provide a greater understanding of the challenges faced by young women in relation to participation in weight management programs and some of the potential methods that could be utilised to facilitate participation.
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Affiliation(s)
- Natalie D Crino
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Helen M Parker
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Exercise and Sports Science, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Janelle A Gifford
- Exercise and Sports Science, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - K Y Karen Lau
- Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Cheyne E Donges
- School of Exercise Science, Sport and Health, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Nicholas J O'Dwyer
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Exercise and Sports Science, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.,School of Exercise Science, Sport and Health, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Katharine S Steinbeck
- The Children's Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
| | - Helen T O'Connor
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Exercise and Sports Science, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
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157
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158
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Chalela P, Muñoz E, Gallion KJ, Kaklamani V, Ramirez AG. Empowering Latina breast cancer patients to make informed decisions about clinical trials: a pilot study. Transl Behav Med 2018; 8:439-449. [PMID: 29800408 DOI: 10.1093/tbm/ibx083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Minority representation in clinical trials is vital for researchers to assess differential effects in outcomes of therapies on biological and genetic characteristics among groups. This study assessed the effect of Choices, a bilingual multi-component intervention, on perceived understanding of clinical trials, agreement with stages of decision readiness and consideration of clinical trials as a treatment option, among Latina breast cancer patients. This randomized controlled pilot study compared Choices with a control condition providing general clinical trial information to eligible patients. Seventy-seven Latina breast cancer patients were randomly assigned to either Choices (n = 38) or the control (n = 39). Choices included three components: an educational interactive video, a low-literacy booklet, and care coordination by patient navigation (i.e., educational and psychosocial support, coordinating appointments, translating, interacting with the medical team). Choices was more effective than the control in improving perceived understanding of clinical trials (p = .033) and increasing consideration of clinical trials as a treatment option (p = .008). Additionally, intervention participants showed significant changes between baseline and post-intervention on agreement with stages of decision readiness statements (p < .002) than control participants (p > .05); the percentage of intervention women in agreement with preparation to action statements increased from 52.8% at baseline to 86.1% at post-intervention, and those in agreement with ready to action stages rose from 50.0% to 88.9%. Computer-based videos and care coordination provided by patient navigation-specifically tailored to Latinos-are effective strategies to successfully address awareness, and improved decision-making skills to make informed decisions about clinical trial participation.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Edgar Muñoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Kipling J Gallion
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Virginia Kaklamani
- Cancer Therapy and Research Center, UT Health San Antonio, San Antonio, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
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159
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Sherratt FC, Roper L, Stones SR, McErlane F, Peak M, Beresford MW, Foster H, Ramanan AV, Rooney M, Baildam E, Young B. Protective parents and permissive children: what qualitative interviews with parents and children can tell us about the feasibility of juvenile idiopathic arthritis trials. Pediatr Rheumatol Online J 2018; 16:76. [PMID: 30514320 PMCID: PMC6278083 DOI: 10.1186/s12969-018-0293-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient recruitment can be very challenging in paediatric studies, especially in relatively uncommon conditions, such as juvenile idiopathic arthritis (JIA). However, involving children and young people (CYP) in the design of such trials could promise a more rapid trajectory towards making evidence-based treatments available. Studies involving CYP are advocated in the literature but we are not aware of any early stage feasibility studies that have qualitatively accessed the perspectives of parents and CYP with a long term condition to inform design and conduct of a trial. In the context of a feasibility study to inform the design of a proposed randomised controlled trial of corticosteroid induction regimen in JIA, we explored families' perspectives on the proposed trial and on JIA trials generally. METHODS We analysed interviews with 27 participants (8 CYP aged 8-16 years and 19 parents) from four UK paediatric rheumatology centres. CYP had recently received corticosteroids to treat JIA. Audio-recorded interviews were transcribed and analysed thematically, drawing on the Framework Method. RESULTS Both parents and CYP were capable of engaging with the logic of the proposed trial but pointed to challenges with its design. Treatment preferences influenced willingness to participate in the proposed trial. The preferences of older children and their parents often differed, with CYP being more willing to participate in the proposed trial than parents. Families' current treatment preferences were largely informed by past positive and negative treatment experiences. Some participants also indicated that their treatment preferences were influenced by those of their clinicians. CONCLUSION Previous research has typically focused on deficits in patients' understandings of trials. We found that both parents and CYP understood trial concepts and were able to identify potential flaws in the proposed trial. We propose recommendations to optimise the design of a planned corticosteroid induction regimen trial in JIA. Accessing both parents' and CYP's perspectives helps to identify and address recruitment challenges, which will ultimately optimise informed consent and future recruitment.
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Affiliation(s)
- Frances C. Sherratt
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Louise Roper
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Simon R. Stones
- 0000 0004 1936 8403grid.9909.9School of Healthcare, University of Leeds, Leeds, UK
| | - Flora McErlane
- 0000 0004 4904 7256grid.459561.aGreat North Children’s Hospital, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Peak
- 0000 0004 0421 1374grid.417858.7Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Michael W. Beresford
- 0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK ,0000 0004 1936 8470grid.10025.36Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Helen Foster
- 0000 0004 4904 7256grid.459561.aGreat North Children’s Hospital, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 1936 7603grid.5337.2University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Rooney
- 0000 0004 0374 7521grid.4777.3School of Medicine, Dentistry and Biomedical Sciences, Queens University of Belfast, Belfast, UK
| | - Eileen Baildam
- 0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Bridget Young
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
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160
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Rudnas B, Montanari E, Dall'Agata M, Petracci E, Nanni O. Patients' understanding of clinical research: An Italian cancer patient survey. TUMORI JOURNAL 2018; 105:31-37. [PMID: 30474502 DOI: 10.1177/0300891618811281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION: Patients' awareness of clinical research and their involvement in clinical trials is of great importance, but it is difficult to estimate the extent of knowledge on the research being undertaken. METHODS: We evaluated the level of knowledge about clinical research using a self-reporting survey distributed to 967 adult patients with cancer attending the Departments of Medical Oncology and Onco-Haematology Units of IRST IRCCS and 4 hospitals in the region of Emilia-Romagna, Italy. The questionnaire was composed of 10 specific items on research knowledge. Patients responding correctly to at least 8 of the 10 items were considered to have a good understanding of clinical research. RESULTS: The questionnaire was completed by 769 patients (response rate 79.5%). Only 19% of patients were found to have a good understanding of clinical research. Patients with higher education and those who had previous clinical trial experience showed a significantly better understanding. Fifty-three percent of patients said that they would be willing to participate in a trial studying a new drug and 75% expressed an interest in taking part in informative meetings/events about clinical studies. CONCLUSIONS: Our results show that patients' understanding of clinical research is limited and highlight an interest in learning more.
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Affiliation(s)
- Britt Rudnas
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Montanari
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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161
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Eichner FA, Groenwold RHH, Grobbee DE, Oude Rengerink K. Systematic review showed that stepped-wedge cluster randomized trials often did not reach their planned sample size. J Clin Epidemiol 2018; 107:89-100. [PMID: 30458261 DOI: 10.1016/j.jclinepi.2018.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine how often stepped-wedge cluster randomized controlled trials reach their planned sample size, and what reasons are reported for choosing a stepped-wedge trial design. STUDY DESIGN AND SETTING We conducted a PubMed literature search (period 2012 to 2017) and included articles describing the results of a stepped-wedge cluster randomized trial. We calculated the percentage of studies reaching their prespecified number of participants and clusters, and we summarized the reasons for choosing the stepped-wedge trial design as well as difficulties during enrollment. RESULTS Forty-six individual stepped-wedge studies from a total of 53 articles were included in our review. Of the 35 studies, for which recruitment rate could be calculated, 69% recruited their planned number of participants, with 80% having recruited the planned number of clusters. Ethical reasons were the most common motivation for choosing the stepped-wedge trial design. Most important difficulties during study conduct were dropout of clusters and delayed implementation of the intervention. CONCLUSION About half of recently published stepped-wedge trials reached their planned sample size indicating that recruitment is also a major problem in these trials. Still, the stepped-wedge trial design can yield practical, ethical, and methodological advantages.
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Affiliation(s)
- Felizitas A Eichner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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162
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Improving Oncology Clinical Trial Participation and Experience. Trends Cancer 2018; 4:793-796. [PMID: 30470299 DOI: 10.1016/j.trecan.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
Abstract
Cancer patients are underrepresented in clinical trial populations because of protocol-, physician-, and patient-related barriers. We engaged focus groups of patients who had participated in breast and ovarian cancer trials to identify concerns regarding their experiences. The lessons learnt are applicable to improving patient experience during future trials.
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163
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Kern-Goldberger AS, Hessels AJ, Saiman L, Quittell LM. Understanding of safety monitoring in clinical trials by individuals with CF or their parents: A qualitative analysis. J Cyst Fibros 2018; 17:736-741. [DOI: 10.1016/j.jcf.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 11/29/2022]
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164
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Kamen CS, Quinn GP, Asare M, Heckler CE, Guido JJ, Giguere JK, Gilliland K, Liu JJ, Geer J, Delacroix SE, Morrow GR, Jacobsen PB. Multimedia psychoeducation for patients with cancer who are eligible for clinical trials: A randomized clinical trial. Cancer 2018; 124:4504-4511. [PMID: 30291797 DOI: 10.1002/cncr.31771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Supporting patients' decision making about clinical trials may enhance trial participation. To date, few theory-based interventions have been tested to address this issue. The objective of the current study was aimed to evaluate the effect of a multimedia psychoeducation (MP) intervention, relative to a print education (PE) intervention, on patients' decision support needs and attitudes about clinical trials. METHODS Patients with cancer who were eligible for participation in a National Cancer Institute therapeutic cancer clinical trial were recruited through the nationwide University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program from 2014 to 2016 and were randomized to the MP or PE intervention. Assessments at baseline (before intervention), postintervention, and at a 2-month follow-up visit included patients' decision support needs, attitudes regarding clinical trials, and clinical trial participation. RESULTS In total, 418 patients with various types of cancer were recruited (ages 26-89 years). Relative to the PE intervention, the MP intervention did not significantly affect decision support needs. However, patients in the MP arm reported significantly more positive attitudes about clinical trials and were more likely to participate in a clinical trial than those in the PE arm (69% vs 62%; P = .01). Furthermore, an improvement in attitudes about clinical trials significantly mediated the effect of the intervention on participation in clinical trials. CONCLUSIONS The MP intervention was able to improve patient attitudes toward clinical trials compared with the PE intervention, and this improvement led to increased rates of participation in trials. The MP intervention could be disseminated to improve attitudes about clinical trials among patients with cancer.
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Affiliation(s)
- Charles S Kamen
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gwendolyn P Quinn
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida.,Department of Obstetrics and Gynecology, New York University Medical Center, New York, New York
| | - Matthew Asare
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Charles E Heckler
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Joseph J Guido
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | | | - Kari Gilliland
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jane Jijun Liu
- Heartland National Cancer Institute Community Oncology Research Program, Decatur, Illinois
| | - Jodi Geer
- Metro-Minnesota National Cancer Institute Community Oncology Research Program, St. Louis Park, Minnesota
| | - Scott E Delacroix
- Gulf South Minority Underserved National Cancer Institute Community Oncology Research Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Paul B Jacobsen
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida
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Kessel KA, Vogel MME, Kessel C, Bier H, Biedermann T, Friess H, Herschbach P, von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Bassermann F, Schmid R, Schwaiger M, Combs SE. Cancer clinical trials - Survey evaluating patient participation and acceptance in a university-based Comprehensive Cancer Center (CCC). Clin Transl Radiat Oncol 2018; 13:44-49. [PMID: 30345398 PMCID: PMC6192009 DOI: 10.1016/j.ctro.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
>50% of patients are willing to participate in clinical trials, only 18% are currently enrolled. The top reason to participate in trials was to serve medical progress and cancer research. Reasons for refusing were extensive travel time, no therapeutic advantage and too time-consuming. Good information strategies need to be implemented, and doctors need to be aware of running trials. Trial concepts must include patients’ needs, e.g. number of appointments, risk-benefit profile.
Introduction Prospective clinical trials are essential to translate new therapy concepts or rather any scientific development into the medical routine. Besides a sophisticated trial protocol, the success of clinical trials depends on patient recruitment and participation. Patient recruitment remains a challenge and depends on several factors. To get a current picture of the patients’ attitude, we conducted the present survey. Methods We designed a survey with seven questions, which was given to all oncological patients treated within a timeframe of three months between Mai and July 2017. Participation was voluntary and anonymous. The questionnaire mainly inquires patients’ participation in clinical trials in a university-based setting, their attitude towards clinical trials regarding risks and benefits, and their source of information in this context. Results 771 patients (1:1 male/female) participated with a median age of 61 years (range 18–91 years) with a response rate of 71.5%. Of all, 17.8% (137/771) were participating in a clinical trial. The most mentioned reason was to serve medical progress and cancer research. Out of the patients not currently participating in a trial, 79 (12.7%, 79/623) refusers named the following main reasons: extensive travel time to the clinic, no therapeutic advantage, and too time-consuming. Out of the patients not offered to take part in a trial, 265 (51.0%, 265/520) would participate if offered. Of all patients, 8.3% (64/771) used the clinics' homepage as a source of information, of those 79.7% (51/64) were satisfied with its content. To enhance patient recruitment strategies, we asked how patients wish to be informed about possible trials: More than half (52.0%) of the questioned patients preferred an individual medical consultation with their physician. We further analyzed the trial participation depending on age, gender, unit, and tumor entity. We could show a significant influence of age (p < 0.001) but not for gender (p = 0.724). The trial participation was also significantly associated with the treating unit (p < 0.001) and tumor entity (p = 0.001). Conclusion Patients are willing to participate in clinical trials. Better information strategies need to be implemented. Physicians need to be aware of running trials within their department and must counseling counsel patients effectively to improve recruitment. Trial concepts should keep in mind patients’ needs including an adequate number of appointments, positive risk-benefit profiles, and information material.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Carmen Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Henning Bier
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Otorhinolaryngology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Tilo Biedermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Biedersteiner Straße 29, Munich, Germany
| | - Helmut Friess
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Peter Herschbach
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich (TUM), Trogerstraße 26, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Orthopedic Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Bernhard Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marion Kiechle
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gynecology and Obstetrics, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Ulrich Keller
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christian Peschel
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Florian Bassermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Roland Schmid
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gastroentereology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Markus Schwaiger
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Nuclear Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
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Weller D. In our March 2017 issue of EJCC…. Eur J Cancer Care (Engl) 2018; 26. [PMID: 28244270 DOI: 10.1111/ecc.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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167
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Kick K, Assfalg R, Aydin S, Bechtold-Dalla Pozza S, Böcker D, Braig S, Bunk M, Dunstheimer D, Durmashkina A, Ermer U, Gavazzeni A, Gerstl EM, Heinrich M, Herbst M, Kriesen Y, Kuhnle-Krahl U, Müller H, Nellen-Hellmuth N, Ockert C, Ramminger C, Sindichakis M, Tretter S, Warncke K, Achenbach P, Ziegler AG, Hoffmann VS. Recruiting young pre-symptomatic children for a clinical trial in type 1 diabetes: Insights from the Fr1da insulin intervention study. Contemp Clin Trials Commun 2018; 11:170-173. [PMID: 30197933 PMCID: PMC6126533 DOI: 10.1016/j.conctc.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children. Aim Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation. Methods Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview. Results Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw. Conclusion The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed.
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Affiliation(s)
- Kerstin Kick
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Susanne Aydin
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | | | | | | | - Melanie Bunk
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | - Alevtina Durmashkina
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Uwe Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | | | | | - Melanie Heinrich
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Melanie Herbst
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Yvonne Kriesen
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | | | | | - Claudia Ramminger
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | - Katharina Warncke
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Department of Pediatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Achenbach
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Anette-G. Ziegler
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
| | - Verena S. Hoffmann
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
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Sommer C, Zuccolin D, Arnera V, Schmitz N, Adolfsson P, Colombo N, Gilg R, McDowell B. Building clinical trials around patients: Evaluation and comparison of decentralized and conventional site models in patients with low back pain. Contemp Clin Trials Commun 2018; 11:120-126. [PMID: 30094387 PMCID: PMC6072894 DOI: 10.1016/j.conctc.2018.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Clinical trials are slow and costly, built around the research centers that study local participants. Building clinical trials around patients in their homes and community through remote visits and monitoring could enhance recruitment and increase convenience for participants. This study evaluated different trial settings, a decentralized arm via telemedicine center (virtual study conduct), a conventional arm via health clinic (onsite study conduct) and a mixed model arm. Acute low-back pain patients (20-65 years) were recruited to this non-interventional trial in Switzerland. The study consisted of a screening period and a 2-week data collection period using direct data capture (eSource), electronic informed consent form (eICF), electronic diary (eDiary) and wearable actigraphy sensor. A higher number of patients were enrolled in the decentralized arm (N = 18) compared to the conventional arm (N = 5) and none in the mixed model arm. The decentralized arm consisted of a diverse population with increased participation from rural areas. In the decentralized arm 89% of enrolled patients completed the study compared to 60% in the conventional arm. All the patients reported satisfaction with the use of eICF, eDiary and remote visits; whereas patients reported a lower level of satisfaction with the wearable sensor. The decentralized setting was operationally feasible and well accepted by patients. Faster recruitment and improved access to patients was observed in the decentralized arm. This study supports broader adoption of the decentralized model in clinical trials, though further investigations in larger interventional trials are needed to confirm the benefits from this patient-centric approach.
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169
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East African Perceptions of Barriers/Facilitators for Pediatric Clinical Research Participation and Development of the Inclusive Research Model. J Pediatr Nurs 2018; 42:104-110. [PMID: 29784519 DOI: 10.1016/j.pedn.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/12/2018] [Accepted: 05/12/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE This study sought to gain a greater understanding of perceptions related to barriers/facilitators for pediatric (ages 0-17) clinical research participation among East African immigrant community members. DESIGN AND METHODS Community leader interviews (n = 6) and focus groups with lay members (n = 16) from the three largest East African communities in the Seattle area (Eritrean, Ethiopian and Somali) were conducted. Discussions were semi-structured based on existing barrier/facilitator research and analyzed using directed content analysis to identify major themes. RESULTS Analysis revealed two novel barrier sub-themes: inadequate interpretation and translation of information even when services were available and a lack of adequate vocabulary in preferred languages. Participants also confirmed previously identified logistical barriers/facilitators (lack of knowledge regarding clinical research; time, cost, transportation, and child care challenges; providing incentives) and psychosocial barriers/facilitators (mistrust of research; cultural and/or religious differences; connecting benefits to the community; involving religious/community leaders or organizations and including community members on the research team; transparency in the research process; presenting results to the community) for clinical research participation among underrepresented groups. CONCLUSION Perceptions of barriers/facilitators for pediatric clinical research participation among East African immigrants identified two novel sub-themes and confirmed those previously described by other underrepresented communities. PRACTICE IMPLICATIONS To facilitate more inclusive research participation, researchers, nurses and other health care providers might consider ensuring adequate time for discussion of the research study and process, engaging the community in the research process, employing lay reviews of translated materials and/or oral consent processes, and other strategies outlined in the Inclusive Research Model.
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170
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Benjaminy S, Lo C, Illes J, Traboulsee A. Reflections on translation: Views of participants in a multisite Canadian CCSVI clinical trial. Neurol Clin Pract 2018; 8:232-239. [PMID: 30105163 DOI: 10.1212/cpj.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/21/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to characterize the perspectives of participants in Canada's phase I/II chronic cerebrospinal venous insufficiency (CCSVI) clinical trial prior to and after the disclosure of trial results. Methods This was a researcher-administered survey of individuals who participated in Canada's CCSVI trial (Clincialtrials.gov, NCT01864941) about their (1) motivations for participating, (2) understanding of the trial process, and (3) perspectives on the social value of the trial. Results A total of 63 participants completed the survey. Participants were motivated to participate by altruism (mean score = 4.56 out of 5) and a desire to access the intervention in Canada (mean score = 3.63 out of 5). Many participants expected medical benefits, such as partial disease reversal (mean score = 3.32 out of 5). Participants felt strongly that the crossover trial design promoted fairness (mean score = 4.65 out of 5). Participants' familiarity with the CCSVI controversy increased significantly after the results were revealed (p = 0.0001). Despite negative trial results, participants still felt that the trial was an appropriate use of tax dollars (mean score = 4.68 out of 5). Many (38%) upheld the belief that further CCSVI research is necessary (responses of 4 out of 5 or higher). Conclusions There is a strong movement in science today to ensure that research agendas reflect the perspectives of multiple stakeholders, including research participants. While previous work suggests that negative findings adversely affect trust in science, the perspectives of participants in this study demonstrate that good trial design and resilience can prevail over expected tensions.
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Affiliation(s)
- Shelly Benjaminy
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Cody Lo
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Judy Illes
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Anthony Traboulsee
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
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Palmer-Wackerly AL, Dailey PM, Krok-Schoen JL, Rhodes ND, Krieger JL. Patient Perceptions of Illness Identity in Cancer Clinical Trial Decision-Making. HEALTH COMMUNICATION 2018; 33:1045-1054. [PMID: 28622019 PMCID: PMC6145173 DOI: 10.1080/10410236.2017.1331189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When patients are diagnosed with cancer, they begin to negotiate their illness identity in relation to their past and future selves, their relationships, and their group memberships. Thus, how patients view their cancer in relation to their other identities may affect how and why they make particular decisions about treatment options. Using the Communication Theory of Identity (CTI), the current study explores: (1) how and why illness identity is framed across identity layers in relation to one particular cancer treatment: participation in a cancer clinical trial (CT); and (2) how and why patients experience identity conflicts while making their treatment decisions. Semi-structured, in-depth interviews were analyzed for 46 cancer patients who were offered a CT. Results of a grounded theory analysis indicated that patients expressed separate identity frames (e.g., personal, relational, and communal), aligned identity frames (e.g., personal and communal), and identity conflicts (e.g., personal-personal). This study theoretically shows how and why patient illness identity relates to cancer treatment decision-making as well as how and why patients relate (and conflict) with the cancer communal identity frame. Practical implications include how healthcare providers and family members can support patient decision-making through awareness of and accommodating to identity shifts.
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Affiliation(s)
- Angela L. Palmer-Wackerly
- Correspondence concerning this manuscript should be addressed to Angela L. Palmer-Wackerly, Department of Communication Studies, The University of Nebraska-Lincoln, Lincoln, NE 68588, USA.
| | | | | | - Nancy D. Rhodes
- Department of Advertising & Public Relations, Michigan State University
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Henshall C, Narendran P, Andrews RC, Daley A, Stokes KA, Kennedy A, Greenfield S. Qualitative study of barriers to clinical trial retention in adults with recently diagnosed type 1 diabetes. BMJ Open 2018; 8:e022353. [PMID: 30018100 PMCID: PMC6059261 DOI: 10.1136/bmjopen-2018-022353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Regular physical exercise may preserve β cell function in newly diagnosed adults with type 1 diabetes (T1D). However, clinical trials to test this theory require the recruitment and retention of adults with new-onset T1D, which can be challenging. We sought to determine the overall experiences of newly diagnosed adults with T1D in an exercise study, to understand issues that influence the retention of trial participants in such studies. DESIGN Qualitative methodology using individual face-to-face (n=6) and telephone interviews (n=14). Interview transcripts were thematically analysed using the framework method. SETTING The study took place at five participating UK hospitals. PARTICIPANTS Twenty participants, aged 19-55 years, in the Exercise for Type 1 Diabetes study were interviewed to explore their study experiences and identify motivators and deterrents towards the study. Participants in control and intervention arms were interviewed, as were people with T1D who had completed (n=16) and withdrawn (n=4). RESULTS Participants revealed barriers and facilitators to retention; the majority were generalisable to clinical trials of people with newly diagnosed T1D. Coming to terms with a diagnosis of T1D, lack of time, work pressures, level of health professional support, volume, clarity and consistency of information and feedback and a desire for knowledge about their condition were all cited as influencing factors to trial retention. CONCLUSIONS To our knowledge, this is the first qualitative study to examine the experience of being involved in an exercise trial by people with T1D. Findings suggest appointments could be shorter, available outside of working hours and planned longer in advance; study information should be clear, consistent and in electronic and paper formats; questionnaires need minimising; healthcare support and feedback needs providing regularly; thought is required around how to support non-exercising arm participants. These considerations may improve participant retention rates in new-onset T1D studies.
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Affiliation(s)
| | - Parth Narendran
- Institute or Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Amy Kennedy
- Department of Diabetes & Endocrinology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Markman M. Progressing precision medicine in a world of randomized trials. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1496014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Maurie Markman
- Department of Medical Oncology, Cancer Treatment Centers of America, Philadelphia, PA, USA
- Department of Medical Oncology, Drexel University College of Medicine, Philadelphia, PA, USA
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Hillyer GC, MacLean SA, Beauchemin M, Basch CH, Schmitt KM, Segall L, Kelsen M, Brogan FL, Schwartz GK. YouTube Videos as a Source of Information About Clinical Trials: Observational Study. JMIR Cancer 2018; 4:e10060. [PMID: 29945855 PMCID: PMC6039767 DOI: 10.2196/10060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Clinical trials are essential to the advancement of cancer treatment but fewer than 5% of adult cancer patients enroll in a trial. A commonly cited barrier to participation is the lack of understanding about clinical trials. OBJECTIVE Since the internet is a popular source of health-related information and YouTube is the second most visited website in the world, we examined the content of the top 115 YouTube videos about clinical trials to evaluate clinical trial information available through this medium. METHODS YouTube videos posted prior to March 2017 were searched using selected keywords. A snowballing technique was used to identify videos wherein sequential screening of the autofill search results for each set of keywords was conducted. Video characteristics (eg, number of views and video length) were recorded. The content was broadly grouped as related to purpose, phases, design, safety and ethics, and participant considerations. Stepwise multivariable logistic regression analysis was conducted to assess associations between video type (cancer vs noncancer) and video characteristics and content. RESULTS In total, 115 videos were reviewed. Of these, 46/115 (40.0%) were cancer clinical trials videos and 69/115 (60.0%) were noncancer/general clinical trial videos. Most videos were created by health care organizations/cancer centers (34/115, 29.6%), were oriented toward patients (67/115, 58.3%) and the general public (68/115, 59.1%), and were informational (79/115, 68.7%); altruism was a common theme (31/115, 27.0%). Compared with noncancer videos, cancer clinical trials videos more frequently used an affective communication style and mentioned the benefits of participation. Cancer clinical trial videos were also much more likely to raise the issue of costs associated with participation (odds ratio [OR] 5.93, 95% CI 1.15-29.46) and advise patients to communicate with their physician about cancer clinical trials (OR 4.94, 95% CI 1.39-17.56). CONCLUSIONS Collectively, YouTube clinical trial videos provided information on many aspects of trials; however, individual videos tended to focus on selected topics with varying levels of detail. Cancer clinical trial videos were more emotional in style and positive in tone and provided information on the important topics of cost and communication. Patients are encouraged to verify and supplement YouTube video information in consultations with their health care professionals to obtain a full and accurate picture of cancer clinical trials to make an adequately informed decision about participation.
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Affiliation(s)
- Grace Clarke Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Sarah A MacLean
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Melissa Beauchemin
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
- New York Presbyterian Hospital, New York, NY, United States
- Columbia University School of Nursing, New York, NY, United States
| | - Corey H Basch
- Department of Public Health, William Paterson University, Paterson, NJ, United States
| | | | - Leslie Segall
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Moshe Kelsen
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Frances L Brogan
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, New York, NY, United States
- Division of Hematology and Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, United States
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176
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Forcina V, Vakeesan B, Paulo C, Mitchell L, Bell JA, Tam S, Wang K, Gupta AA, Lewin J. Perceptions and attitudes toward clinical trials in adolescent and young adults with cancer: a systematic review. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:87-94. [PMID: 29942170 PMCID: PMC6005317 DOI: 10.2147/ahmt.s163121] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Although cancer clinical trials (CT) offer opportunities for novel treatments that may lead to improved outcomes, adolescents and young adults (AYA) are less likely to participate in these trials as compared to younger children and older adults. We aimed to identify the perceptions and attitudes toward CT in AYA that influence trial participation. Materials and methods A systematic review of cancer literature was conducted that assessed perceptions and attitudes toward CT enrollment limited to AYA patients (defined as age 15–39). We estimated the frequency of identified themes by pooling identified studies. Results In total, six original research articles were identified that specifically addressed perceptions or attitudes that influenced CT participation in AYA patients. Three studies were conducted at pediatric centers – one at an AYA unit, one at an adult cancer hospital, and one was registry based. Major themes identified for CT acceptability included: hope for positive clinical affect, altruism, and having autonomy. Potential deterrents included: prolonged hospitalization, worry of side effects, and discomfort with experimentation. Conclusion Limited information is available with regard to the perceptions and attitudes toward CT acceptability among AYA patients, especially those treated at adult cancer centers, which prevents generalization of data and themes. Future research assessing strategies for understanding and supporting CT decision-making processes among AYA represents a key focus for future funding to improve CT enrollment.
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Affiliation(s)
- Victoria Forcina
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Branavan Vakeesan
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Chelsea Paulo
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer Ah Bell
- Joint Center for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Kate Wang
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,ONTrac, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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177
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Bell JA, Forcina V, Mitchell L, Tam S, Wang K, Gupta AA, Lewin J. Perceptions of and decision making about clinical trials in adolescent and young adults with Cancer: a qualitative analysis. BMC Cancer 2018; 18:629. [PMID: 29866065 PMCID: PMC5987432 DOI: 10.1186/s12885-018-4515-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adolescent and young adults (AYA) enrolment rates into cancer clinical trials (CCT) are the lowest of any age group globally. As AYA have distinct biological, psychosocial and relational needs, we aimed to explore any unique factors influencing their CCT decision-making process, including AYA-specific perceptions or attitudes towards CCT. METHODS Qualitative interpretive descriptive methodology was used to explore AYA perceptions and decision-making related to CCT. An analytic approach conducive to inductive imagining and exploratory questioning was used in order to generate insights and interpret data. RESULTS A total of 21 AYA were interviewed (median age: 31 (18-39)). Twelve (57%) participants had previously been approached to participate in CCT. Major themes influencing trial enrolment decisions were: 1) severity of illness/urgency for new treatment 2) side effect profile of investigational drug in the short and long term (e.g., impact on future quality of life) 3) who approached patient for trial participation (oncologist vs. other) 4) additional information found on-line about the trial and investigators, and 5) family, friends and peer group opinion regarding the CCT. CONCLUSIONS Several psychosocial and relational factors were identified as influencing AYA CCT decisions, some of which are unique to this demographic. Specific strategies to address barriers to CCT and enable supportive decision-making include: 1) involving family in decision-making and 2) helping AYA appreciate short- and long-term implications of trial participation. Finally, exploring social networking and general education about CCT that AYA can independently access may increase participation.
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Affiliation(s)
- Jennifer A.H. Bell
- Joint Center for Bioethics, University of Toronto, Toronto, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Victoria Forcina
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kate Wang
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- Present Address: OnTrac at PeterMac, Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
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van Leeuwen N, Lingsma HF, Mooijaart SP, Nieboer D, Trompet S, Steyerberg EW. Regression discontinuity was a valid design for dichotomous outcomes in three randomized trials. J Clin Epidemiol 2018; 98:70-79. [DOI: 10.1016/j.jclinepi.2018.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
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Hall-Lipsy E, Barraza L, Robertson C. Practice-Based Research Networks and the Mandate for Real-World Evidence. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:219-236. [PMID: 30106651 DOI: 10.1177/0098858818789428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The 21st Century Cures Act encourages the Food and Drug Administration to consider "real-world evidence" in its regulation of the safety and efficacy of drugs and devices. Many have interpreted this mandate to focus on non-randomized observational research. However, we suggest that regulatory science must also move from rarefied academic hospitals to community-based settings, where the vast majority of patients in fact receive care in the fragmented U.S. healthcare system. This move is especially important if innovations are to reach, and be validated in, more diverse populations. A solution can be found in the 183 Practiced-Based Research Networks ("PBRN"), i.e., groups of primary care clinicians and practices in all 50 states working to improve clinical care and translate research findings into practice. This symposium contribution seeks to (1) describe some of the common shortcomings of clinical trials, (2) explore the opportunities and challenges posed by use of real-world evidence as a basis for drug and device regulation, (3) briefly describe the history and evolution of PBRNs, and (4) articulate the challenges and opportunities for using PBRNs to fulfill the 21st Century Cures Act mandate for real-world evidence.
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Affiliation(s)
| | - Leila Barraza
- J.D., M.P.H.; Assistant Professor, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Christopher Robertson
- J.D., Ph.D.; Professor of Law; Associate Dean for Research & Innovation, James E. Rogers College of Law, University of Arizona
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180
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Dunleavy L, Walshe C, Oriani A, Preston N. Using the 'Social Marketing Mix Framework' to explore recruitment barriers and facilitators in palliative care randomised controlled trials? A narrative synthesis review. Palliat Med 2018; 32:990-1009. [PMID: 29485314 DOI: 10.1177/0269216318757623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effective recruitment to randomised controlled trials is critically important for a robust, trustworthy evidence base in palliative care. Many trials fail to achieve recruitment targets, but the reasons for this are poorly understood. Understanding barriers and facilitators is a critical step in designing optimal recruitment strategies. AIM To identify, explore and synthesise knowledge about recruitment barriers and facilitators in palliative care trials using the '6 Ps' of the 'Social Marketing Mix Framework'. DESIGN A systematic review with narrative synthesis. DATA SOURCES Medline, CINAHL, PsycINFO and Embase databases (from January 1990 to early October 2016) were searched. Papers included the following: interventional and qualitative studies addressing recruitment, palliative care randomised controlled trial papers or reports containing narrative observations about the barriers, facilitators or strategies to increase recruitment. RESULTS A total of 48 papers met the inclusion criteria. Uninterested participants (Product), burden of illness (Price) and 'identifying eligible participants' were barriers. Careful messaging and the use of scripts/role play (Promotion) were recommended. The need for intensive resources and gatekeeping by professionals were barriers while having research staff on-site and lead clinician support (Working with Partners) was advocated. Most evidence is based on researchers' own reports of experiences of recruiting to trials rather than independent evaluation. CONCLUSION The 'Social Marketing Mix Framework' can help guide researchers when planning and implementing their recruitment strategy but suggested strategies need to be tested within embedded clinical trials. The findings of this review are applicable to all palliative care research and not just randomised controlled trials.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Anna Oriani
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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181
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Mahmud A, Zalay O, Springer A, Arts K, Eisenhauer E. Barriers to participation in clinical trials: a physician survey. ACTA ACUST UNITED AC 2018; 25:119-125. [PMID: 29719427 DOI: 10.3747/co.25.3857] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation. Methods To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions. Results The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services. Conclusions The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.
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Affiliation(s)
| | | | - A Springer
- Department of Health Sciences, Queen's University, Kingston, ON
| | - K Arts
- Canadian Cancer Clinical Trials Network, Toronto, ON
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182
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Hardesty JJ, Kanarek NF. Barriers to non-small cell lung cancer trial eligibility. Contemp Clin Trials Commun 2018; 9:45-49. [PMID: 29696224 PMCID: PMC5898521 DOI: 10.1016/j.conctc.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Cancer clinical trial (CCT) enrollment is low potentially threatening the generalizability of trial results and expedited regulatory approvals. We assessed whether type of initial patient appointment for non-small cell lung cancer (NSCLC) is associated with CCT eligibility. Methods Using a patient-to-accrual framework, we conducted a quasi-retrospective cohort pilot study at Sidney Kimmel Comprehensive Cancer Center (SKCCC), Baltimore, Maryland. 153 NSCLC patients new to SKCCC were categorized based on type of initial appointment: patients diagnosed or treated and patients seen for a consultation. CCT eligibility was determined by comparing eligibility criteria for each open trial to the electronic medical record (EMR) of each patient at every office visit occurring within 6-months of initial visit. Results We found no association between type of initial appointment and CCT eligibility (OR, 1.15; 95% CI, 0.49-2.73). Analyses did suggest current smokers were less likely to be eligible for trials compared to never smokers (OR, 0.15; 95% CI, 0.03-0.64), and stage 4 patients with second line therapy or greater were more likely to be eligible than stage 1 or 2 patients (OR, 5.18; 95% CI, 1.08-24.75). Additional analyses suggested most current smokers and stage 1 or 2 patients had trials available but were still ineligible. Conclusions SKCCC has a diverse portfolio of trials available for NSCLC patients and should consider research strategies to re-examine eligibility criteria for future trials to ensure increased enrollment of current smokers and stage 1 or 2 patients. We could not confirm whether type of initial visit was related to eligibility.
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Affiliation(s)
- Jeffrey J Hardesty
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Geriatrics Department, USA
| | - Norma F Kanarek
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, USA
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183
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Spellecy R, Tarima S, Denzen E, Moore H, Abhyankar S, Dawson P, Foley A, Gersten I, Horwitz M, Idossa L, Joffe S, Kamani N, King R, Lazaryan A, Morris L, Horowitz MM, Majhail NS. Easy-to-Read Informed Consent Form for Hematopoietic Cell Transplantation Clinical Trials: Results from the Blood and Marrow Transplant Clinical Trials Network 1205 Study. Biol Blood Marrow Transplant 2018; 24:2145-2151. [PMID: 29679770 DOI: 10.1016/j.bbmt.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
Because of the complexity of hematopoietic cell transplant trial treatments, informed consent forms are often long and difficult to read. We evaluated a 2-column easy-to-read informed consent (ETRIC) form that incorporates elements of health literacy and readability in participants and centers participating in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) clinical trials. In a randomized study 198 adult patients from 25 centers potentially eligible to participate in 4 BMT CTN interventional trials were randomized to the ETRIC form or a standard consent form for that trial. Both forms were written at no more than an eighth-grade reading level. The primary endpoint was objective comprehension score on the Quality of Informed Consent, part A (QuIC-A) instrument. In a parallel evaluation study, 2 moderators conducted semistructured interviews of 49 investigators, research staff, and institutional review board (IRB) members at 9 BMT CTN trial sites. The mean QuIC-A scores were comparable in 152 patients (77%) assessable for the primary endpoint (ETRIC form, 80.5; standard form, 81.8; P = .37). In regression analysis there was no significant association between the consent type and QuIC-A score. In the evaluation study dominant themes identified on qualitative analyses included general comfort and willingness to use the ETRIC template and that its formatting and layout enhancements would offer additional value to research participants, investigators, and IRBs. IRB language preferences and requirements, length, and prior experience with alternative consent formats were perceived as barriers. Among patients considering participation in BMT CTN clinical trials, the formatting enhancements of the ETRIC form did not alter comprehension of the trial. Despite local challenges to implementation, trial sites generally viewed the ETRIC form favorably and expressed willingness to use it over standard consent form.
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Affiliation(s)
- Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ellen Denzen
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Heather Moore
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Sunil Abhyankar
- Department of Hematologic Malignancies and Cellular Therapies, Kansas University Medical Center, Kansas City, Kansas
| | | | - Amy Foley
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Mitchell Horwitz
- Department of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Lensa Idossa
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Steven Joffe
- Division of Medical Ethics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Roberta King
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Aleksandr Lazaryan
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Mary M Horowitz
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
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184
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Kunos CA, Massett HA, Galassi A, Walker JL, Good MJ, Díaz LB, McCaskill-Stevens W. Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico. Front Oncol 2018; 8:102. [PMID: 29692980 PMCID: PMC5902541 DOI: 10.3389/fonc.2018.00102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022] Open
Abstract
Women in the U.S. Commonwealth of Puerto Rico (PR) have a higher age-adjusted incidence rate for uterine cervix cancer than the U.S. mainland as well as substantial access and economic barriers to cancer care. The National Cancer Institute (NCI) funds a Minority/Underserved NCI Community Oncology Research Program in PR (PRNCORP) as part of a national network of community-based health-care systems to conduct multisite cancer clinical trials in diverse populations. Participation by the PRNCORP in NCI’s uterine cervix cancer clinical trials, however, has remained limited. This study reports on the findings of an NCI site visit in PR to assess barriers impeding site activation and accrual to its sponsored gynecologic cancer clinical trials. Qualitative, semi-structured individual, and group interviews were conducted at six PRNCORP-affiliated locations to ascertain: long-term trial accrual objectives; key stakeholders in PR that address uterine cervix cancer care; key challenges or barriers to activating and to enrolling patients in NCI uterine cervix cancer treatment trials; and resources, policies, or procedures in place or needed on the island to support NCI-sponsored clinical trials. An NCI-sponsored uterine cervix cancer radiation–chemotherapy intervention clinical trial (NCT02466971), already activated on the island, served as a test case to identify relevant patient accrual and site barriers. The site visit identified five key barriers to accrual: (1) lack of central personnel to coordinate referrals for treatment plans, medical tests, and medical imaging across the island’s clinical trial access points; (2) patient insurance coverage; (3) lack of a coordinated brachytherapy schedule at San Juan-centric service providers; (4) limited credentialed radiotherapy machines island-wide; and (5) too few radiology medical physicists tasked to credential trial-specified positron emission tomography scanners island-wide. PR offers a unique opportunity to study overarching and tactical strategies for improving accrual to NCI-sponsored gynecologic cancer clinical trials. Interview findings support adding and re-tasking personnel for coordinated trial-eligible patient referral, accrual, and treatment.
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Affiliation(s)
- Charles A Kunos
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, United States
| | - Holly A Massett
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, United States
| | - Annette Galassi
- Center for Global Health, National Cancer Institute, Bethesda, MD, United States
| | - Joan L Walker
- Gynecologic Oncology Section, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Marge J Good
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, United States
| | - Luis Báez Díaz
- Minority/Underserved NCI Community Oncology Research Program, San Juan, PR, United States
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185
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Mohamedali M, Sandoval J, Thiruvarooran V, Stacey H, O'Neill M, Breunis H, Timilshina N, Durbano S, Alibhai SMH. Perceptions of Study Newsletters for Older Cancer Patients in Longitudinal Studies. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:463-469. [PMID: 27900661 DOI: 10.1007/s13187-016-1143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
To date, no study has examined the value of providing study newsletters in educating and motivating participants taking part in longitudinal intervention studies and reducing attrition in studies. The study team examined perceptions and satisfaction towards study newsletters, and their potential benefits, in a population of older men with prostate cancer participating in two ongoing longitudinal trials. Two study newsletters issues were mailed out 4 months apart to prostate cancer patients participating in a bone health and/or exercise intervention trial. Participants (n = 133) were invited to complete an 18-item custom-designed survey examining perceptions towards and satisfaction with the newsletter, and provide feedback about what makes an ideal study newsletter. Analyses were primarily descriptive. Resources required to produce a study newsletter were also calculated. Of 133 participants, 83 usable surveys were returned (response rate 62.4%). The mean satisfaction rating for the newsletter was 8.5/10 (SD 1.9) (10 = highly satisfied). Seventy eight percent said the newsletter encouraged them to continue to participate in the study, and 93% indicated that providing such study newsletters should be optional (64%) or mandatory (29%). Each newsletter required 31 h of study personnel time (mostly research student) to produce. Study participants were very satisfied with the newsletter and the majority indicated that study newsletters should be a regular practice in all long-term studies and may improve participant retention. Producing a newsletter is a low-cost method of educating participants in longitudinal studies. Its impact on recruitment and retention should be examined in clinical trials.
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Affiliation(s)
- Mustafa Mohamedali
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Joanna Sandoval
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Vikarnan Thiruvarooran
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Holly Stacey
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Meagan O'Neill
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Henriette Breunis
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, Canada.
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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186
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Kowalski C, Post S, Seufferlein T, Benz SR, Ferencz J, Wesselmann S. Barriers and Facilitating Factors for Research Involvement in Cancer Centers: A Survey of Colorectal Cancer Center Coordinators in Germany, Austria, and Switzerland. Cancer Control 2018; 25:1073274818765475. [PMID: 29592528 PMCID: PMC6852664 DOI: 10.1177/1073274818765475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improvements in health care depend on research involving health-care providers (HCPs) and health-care organizations (HCOs). Existing research suggests that involvement in research studies is still much lower than it could be. This study investigates factors that may impede or facilitate research involvement. A standardized online questionnaire was used to carry out a survey, in 3 countries, of key informants in colorectal cancer centers that hold certification in accordance with the requirements of the German Cancer Society. A total of 184 individuals responded (response rate 65%). The respondents found it difficult to identify studies suitable for their patients (40% agreement), criticized the small overall number of studies available (48%), and found that many studies are not worthwhile financially (56%). Among respondents who were not involved in studies as the principal investigators (PIs), 66% agreed they lacked the research infrastructure needed and 81% that they did not have enough staff. Among respondents who were involved as PIs, only 22% indicated that their hospital management encouraged them to initiate and conduct clinical trials. Eighty-five percent of the respondents agreed that the general population lacks information about the importance of studies. Five recommendations for health policy makers are derived from these findings for ways of increasing the involvement of HCPs and HCOs in research, and in cancer research in particular.
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Affiliation(s)
| | - Stefan Post
- 2 University Medical Center, Mannheim, Germany
| | | | - Stefan R Benz
- 4 Klinikum Böblingen-Sindelfingen, Böblingen, Germany
| | - Julia Ferencz
- 5 OnkoZert GmbH, Certification Institute of the German Cancer Society, Neu-Ulm, Germany
| | - Simone Wesselmann
- 1 Department for Certification, German Cancer Society, Berlin, Germany
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Chhatre S, Jefferson A, Cook R, Meeker CR, Kim JH, Hartz KM, Wong YN, Caruso A, Newman DK, Morales KH, Jayadevappa R. Patient-centered recruitment and retention for a randomized controlled study. Trials 2018; 19:205. [PMID: 29587805 PMCID: PMC5870194 DOI: 10.1186/s13063-018-2578-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background Recruitment and retention strategies for patient-centered outcomes research are evolving and research on the subject is limited. In this work, we present a conceptual model of patient-centered recruitment and retention, and describe the recruitment and retention activities and related challenges in a patient-centered comparative effectiveness trial. Methods This is a multicenter, longitudinal randomized controlled trial in localized prostate cancer patients. Results We recruited 743 participants from three sites over 15 months period (January 2014 to March 2015), and followed them for 24 months. At site 1, of the 773 eligible participants, 551 (72%) were enrolled. At site 2, 34 participants were eligible and 23 (68%) enrolled. Of the 434 eligible participants at site 3, 169 (39%) enrolled. We observed that strategies related to the concepts of trust (e.g., physician involvement, ensuring protection of information), communication (e.g., brochures and pamphlets in physicians’ offices, continued contact during regular clinic visits and calling/emailing assessment), attitude (e.g., emphasizing the altruistic value of research, positive attitude of providers and research staff), and expectations (e.g., full disclosure of study requirements and time commitment, update letters) facilitated successful patient recruitment and retention. A stakeholders’ advisory board provided important input for the recruitment and retention activities. Active engagement, reminders at the offices, and personalized update letters helped retention during follow-up. Usefulness of telephone recruitment was site specific and, at one site, the time requirement for telephone recruitment was a challenge. Conclusions We have presented multilevel strategies for successful recruitment and retention in a clinical trial using a patient-centered approach. Our strategies were flexible to accommodate site-level requirements. These strategies as well as the challenges can aid recruitment and retention efforts of future large-scale, patient-centered research studies. Trial registration Clinicaltrials.gov, ID: NCT02032550. Registered on 22 November 2013.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St. Suite 4051, Philadelphia, PA, 19104, USA.
| | - Ashlie Jefferson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ratna Cook
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin R Meeker
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Ji Hyun Kim
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Yu-Ning Wong
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Adele Caruso
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Knashawn H Morales
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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188
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Mills N, Gaunt D, Blazeby JM, Elliott D, Husbands S, Holding P, Rooshenas L, Jepson M, Young B, Bower P, Tudur Smith C, Gamble C, Donovan JL. Training health professionals to recruit into challenging randomized controlled trials improved confidence: the development of the QuinteT randomized controlled trial recruitment training intervention. J Clin Epidemiol 2018; 95:34-44. [PMID: 29191445 PMCID: PMC5844671 DOI: 10.1016/j.jclinepi.2017.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/31/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe and evaluate a training intervention for recruiting patients to randomized controlled trials (RCTs), particularly for those anticipated to be difficult for recruitment. STUDY DESIGN AND SETTING One of three training workshops was offered to surgeons and one to research nurses. Self-confidence in recruitment was measured through questionnaires before and up to 3 months after training; perceived impact of training on practice was assessed after. Data were analyzed using two-sample t-tests and supplemented with findings from the content analysis of free-text comments. RESULTS Sixty-seven surgeons and 32 nurses attended. Self-confidence scores for all 10 questions increased after training [range of mean scores before 5.1-6.9 and after 6.9-8.2 (scale 0-10, all 95% confidence intervals are above 0 and all P-values <0.05)]. Awareness of hidden challenges of recruitment following training was high-surgeons' mean score 8.8 [standard deviation (SD), 1.2] and nurses' 8.4 (SD, 1.3) (scale 0-10); 50% (19/38) of surgeons and 40% (10/25) of nurses reported on a 4-point Likert scale that training had made "a lot" of difference to their RCT discussions. Analysis of free text revealed this was mostly in relation to how to convey equipoise, explain randomization, and manage treatment preferences. CONCLUSION Surgeons and research nurses reported increased self-confidence in discussing RCTs with patients, a raised awareness of hidden challenges and a positive impact on recruitment practice following QuinteT RCT Recruitment Training. Training will be made more available and evaluated in relation to recruitment rates and informed consent.
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Affiliation(s)
- Nicola Mills
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Daisy Gaunt
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Jane M Blazeby
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Daisy Elliott
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Samantha Husbands
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Leila Rooshenas
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marcus Jepson
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Institute of Psychology Health and Society, University of Liverpool, Block B, Waterhouse Building, Brownlow Street, Liverpool L69 3GL, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Centre for Primary Care, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - Catrin Tudur Smith
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Jenny L Donovan
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
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189
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Recruitment of racial and ethnic minorities to clinical trials conducted within specialty clinics: an intervention mapping approach. Trials 2018; 19:115. [PMID: 29454389 PMCID: PMC5816509 DOI: 10.1186/s13063-018-2507-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Despite efforts to increase diversity in clinical trials, racial/ethnic minority groups generally remain underrepresented, limiting researchers’ ability to test the efficacy and safety of new interventions across diverse populations. We describe the use of a systematic framework, intervention mapping (IM), to develop an intervention to modify recruitment behaviors of coordinators and specialist investigators with the goal of increasing diversity in trials conducted within specialty clinics. To our knowledge IM has not been used in this setting. Methods The IM framework was used to ensure that the intervention components were guided by health behavior theories and the evidence. The IM steps consisted of (1) conducting a needs assessment, (2) identification of determinants and objectives, (3) selection of theory-informed methods and practical applications, (4) development and creation of program components, (5) development of an adoption and implementation plan, and (6) creation of an evaluation plan. Results The intervention included five educational modules, one in-person and four web-based, plus technical assistance calls to coordinators. Modules addressed the intervention rationale, development of clinic-specific plans to obtain minority-serving physician referrals, physician-centered and patient-centered communication, and patient navigation. The evaluation, a randomized trial, was recently completed in 50 specialty clinics and is under analysis. Conclusions Using IM we developed a recruitment intervention that focused on building relationships with minority-serving physicians to encourage minority patient referrals. IM enhanced our understanding of factors that may influence minority recruitment and helped us integrate strategies from multiple disciplines that were relevant for our audience.
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Sylla L, Evans D, Taylor J, Gilbertson A, Palm D, Auerbach JD, Dubé K. If We Build It, Will They Come? Perceptions of HIV Cure-Related Research by People Living with HIV in Four U.S. Cities: A Qualitative Focus Group Study. AIDS Res Hum Retroviruses 2018; 34:56-66. [PMID: 29198134 DOI: 10.1089/aid.2017.0178] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Global interest and investment in the search for an HIV cure has increased. Research has focused on what experts refer to as a sterilizing or eradicating cure, where HIV is eliminated from the body, and on what is often called a functional cure, where HIV remains, kept durably suppressed in the absence of antiretroviral treatment and therapy (ART). Many believe that a functional cure is likely to be found first. HIV cure studies will require active participation by people living with HIV (PLWHIV). Their desires and perceptions will be important to effectively recruit study participants and for the uptake of any future strategy that demonstrates safety and efficacy. The perspectives of PLWHIV are essential to advancing HIV cure research, and they should be taken into consideration as biomedical research advances. We conducted 10 focus groups in four U.S. cities, eliciting perspectives of PLWHIV on HIV cure and cure research. Most participants conceived of a cure as eradicating, and felt favorably toward it. In addition to the physical benefits of a potential cure, participants valued the possible de-stigmatization related to no longer living with HIV, liberation from concerns about transmitting HIV, and freedom from the burden of daily medication. Many participants did not regard a functional cure as an improvement over controlling HIV through ART, were distrustful about viral rebound potential, and noted concerns about medical complications and accompanying psychological distress. Some felt that the risks of HIV cure research were not worth taking. Many were skeptical about science's ability to eliminate HIV from the body.
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Affiliation(s)
- Laurie Sylla
- 1 defeatHIV Community Advisory Board (CAB), Seattle, Washington
| | - David Evans
- 2 Project Inform, Los Angeles, California
- 3 Delaney AIDS Research Enterprise (DARE) CAB, Los Angeles, California
| | - Jeff Taylor
- 4 amfAR Institute for HIV Cure Research CAB , Palm Springs, California
- 5 Collaboratory of AIDS Researchers for Eradication (CARE) CAB , Palm Springs, California and Chapel Hill, North Carolina
| | - Adam Gilbertson
- 6 Department of Social Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - David Palm
- 5 Collaboratory of AIDS Researchers for Eradication (CARE) CAB , Palm Springs, California and Chapel Hill, North Carolina
| | - Judith D Auerbach
- 7 School of Medicine, University of California San Francisco , San Francisco, California
| | - Karine Dubé
- 8 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Laba JM, Senan S, Schellenberg D, Harrow S, Mulroy L, Senthi S, Swaminath A, Kopek N, Pantarotto JR, Pan L, Pearce A, Warner A, Louie AV, Palma DA. Identifying barriers to accrual in radiation oncology randomized trials. ACTA ACUST UNITED AC 2017; 24:e524-e530. [PMID: 29270062 DOI: 10.3747/co.24.3662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Data about factors driving accrual to radiation oncology trials are limited. In oncology, 30%-40% of trials are considered unsuccessful, many because of poor accrual. The goal of the present study was to inform the design of future trials by evaluating the effects of institutional, clinician, and patient factors on accrual rates to a randomized radiation oncology trial. Methods Investigators participating in sabr-comet (NCT01446744), a randomized phase ii trial open in Canada, Europe, and Australia that is evaluating the role of stereotactic ablative radiotherapy (sabr) in oligometastatic disease, were invited to complete a survey about factors affecting accrual. Institutional ethics approval was obtained. The primary endpoint was the annual accrual rate per institution. Univariable and multivariable linear regression analyses were used to identify factors predictive of annual accrual rates. Results On univariable linear regression analysis, off-trial availability of sabr (p = 0.014) and equipoise of the referring physician (p = 0.014) were found to be predictive of annual accrual rates. The annual accrual rates were lower when centres offered sabr for oligometastases off-trial (median: 3.7 patients vs. 8.4 patients enrolled) and when referring physicians felt that, compared with having equipoise, sabr was beneficial (median: 4.8 patients vs. 8.4 patients enrolled). Multivariable analysis identified perceived level of equipoise of the referring physician to be predictive of the annual accrual rate (p = 0.023). Conclusions The level of equipoise of referring physicians might play a key role in accrual to radiation oncology randomized controlled trials. Efforts to communicate with and educate referring physicians might therefore be beneficial for improving trial accrual rates.
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Affiliation(s)
- J M Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, ON
| | - S Senan
- Department of Radiation Oncology, VU University Medical Centre, Amsterdam, Netherlands
| | - D Schellenberg
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC
| | - S Harrow
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - L Mulroy
- Department of Radiation Oncology, Dalhousie University, Halifax, NS
| | - S Senthi
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia
| | - A Swaminath
- Department of Radiation Oncology, Juravinski Cancer Center, Hamilton, ON
| | - N Kopek
- Department of Oncology, McGill University, Montreal, QC
| | - J R Pantarotto
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - L Pan
- Department of Radiation Oncology, Prince Edward Island Cancer Treatment Centre, Charlottetown, PE
| | - A Pearce
- Department of Radiation Oncology, Northeast Cancer Centre, Sudbury, ON
| | - A Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, ON
| | - A V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, ON.,Department of Oncology, Western University, London, ON
| | - D A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, ON.,Department of Oncology, Western University, London, ON
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Eggly S, Hamel LM, Heath E, Manning MA, Albrecht TL, Barton E, Wojda M, Foster T, Carducci M, Lansey D, Wang T, Abdallah R, Abrahamian N, Kim S, Senft N, Penner LA. Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials. BMC Cancer 2017; 17:807. [PMID: 29197371 PMCID: PMC5712160 DOI: 10.1186/s12885-017-3804-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients' decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial. METHODS/DESIGN Data collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients' understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes. DISCUSSION PACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers. TRIAL REGISTRATION Clinical Trials.gov registration number: NCT02906241 (September 8, 2016).
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Mark A. Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Ellen Barton
- Department of English, Wayne State University, 5057 Woodward Suite 9408, Detroit, MI 48202 USA
| | - Mark Wojda
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Tanina Foster
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Michael Carducci
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 1M59 Bunting –Blaustein Cancer Research Building, 1650 Orleans Street, Baltimore, MD 21287 USA
| | - Dina Lansey
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Ting Wang
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Rehab Abdallah
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Narineh Abrahamian
- Johns Hopkins School of Medicine/Sidney Kimmel Comprehensive Cancer Center, 550 North Broadway, 1003-G, Baltimore, MD 21205 USA
| | - Seongho Kim
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201 USA
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Dasher JA, Frugé AD, Snyder DC, Demark-Wahnefried W. Characteristics of cancer patients participating in presurgical lifestyle intervention trials exploring effects on tumor biology. Contemp Clin Trials Commun 2017; 8:209-212. [PMID: 29696211 PMCID: PMC5898572 DOI: 10.1016/j.conctc.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/11/2023] Open
Abstract
Background Poor diet and insufficient physical activity are strongly associated with an increased risk of several cancers. Preclinical studies suggest that lifestyle modifications may exert favorable effects on tumor biology. Randomized controlled trials in the presurgical setting serve as an ideal means to translate this research to humans; however, little is known about the characteristics of patients who enroll in these presurgical trials versus those who do not. Methods Screening databases from three presurgical lifestyle intervention trials for breast and prostate cancer patients conducted at Duke University Medical Center (NCT00049309) and the University of Alabama at Birmingham (NCT02224807 and NCT01886677) were combined for analysis. Demographic and anthropometric differences between enrolled vs. non-enrolled individuals were assessed using Chi-square for categorical variables and t-tests for continuous variables. Results There was no difference in participation rate when comparing minority status or overweight and obese patients. However, obese females were slightly more likely to enroll than women who were overweight (p = 0.110), a trend not seen in men. Women were also less likely than men to participate if their study site was >25 miles from their home (p = 0.034). Patients who had completed a college degree were somewhat less likely to enroll than those with less educational attainment (p = 0.072). Of those who did not enroll, 80% cited a lack of time. Conclusion Similar to other clinical trials, lack of time is a leading barrier to enrollment, and travel/distance appears to be a greater barrier for women in presurgical studies. Larger presurgical lifestyle intervention trials will require tailored strategies to enhance recruitment.
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Affiliation(s)
- John A. Dasher
- University of Alabama at Birmingham (UAB) School of Medicine, Birmingham, AL, United States
- Corresponding author. University of Alabama at Birmingham School of Medicine, WTI 102M, 1824 6th Ave S, Birmingham, AL 35294, United States.
| | - Andrew D. Frugé
- Department of Nutrition Sciences, UAB, Birmingham, AL, United States
| | - Denise C. Snyder
- Duke Office of Clinical Research, Duke University Medical Center, Durham, NC, United States
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Smith A'B, Agar M, Delaney G, Descallar J, Dobell-Brown K, Grand M, Aung J, Patel P, Kaadan N, Girgis A. Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers. Asia Pac J Clin Oncol 2017; 14:52-60. [PMID: 29083094 DOI: 10.1111/ajco.12818] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
AIM Clinical trials play a critical role in advancing cancer care, but international research shows that few cancer patients, particularly culturally and linguistically diverse (CALD) patients, participate in trials. This limits generalizability of trial results and increases health disparities. This study aimed to establish rates and correlates of trial participation among CALD patients in South Western Sydney Local Health District (SWSLHD), a highly culturally diverse area. METHODS Data from all cancer patients diagnosed and/or treated in SWSLHD from January 2006 to July 2016 were analyzed retrospectively. The primary outcome was trial enrolment among patients born in non-English speaking countries (CALD) versus English speaking countries (non-CALD). Multivariable logistic regression evaluated CALD status as a predictor of trial participation. Moderators of trial participation by the different CALD groups, namely those whose preferred language was English (CALD-PLE) or was not English (CALD-PLNE), were examined by testing interactions between CALD status and other demographic and clinical variables. RESULTS A total of 19 453 patients were analyzed (54.9% non-CALD, 16.5% CALD-PLE, 18.5% CALD-PLNE). Overall, 7.4% of patients were enrolled in a trial. Trial participation was significantly lower in CALD patients than non-CALD patients (5.7% vs 8.4%; odds ratio [OR] = 0.80; 95% confidence interval [CI], 0.69-0.91; P = 0.001). CALD-PLNE patients were less likely to participate in trials than non-CALD (OR = 0.45; 95% CI, 0.36-0.56; P < 0.0001) and CALD-PLE patients (OR = 0.53; 95% CI, 0.67-0.41; P < 0.0001). CONCLUSIONS Limited English proficiency seems particularly unfavorable to trial participation. Development and evaluation of strategies to overcome language barriers (e.g. simplified and translated multimedia participant information materials) is needed.
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Affiliation(s)
- Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Meera Agar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Geoff Delaney
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Kelsey Dobell-Brown
- Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Melissa Grand
- Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Jennifer Aung
- Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Pinky Patel
- Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
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Ibraheem A, Polite B. Improving the accrual of racial and ethnic minority patients in clinical trials: Time to raise the stakes. Cancer 2017; 123:4752-4756. [DOI: 10.1002/cncr.31073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 01/08/2023]
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Koutoukidis DA, Beeken RJ, Manchanda R, Michalopoulou M, Burnell M, Knobf MT, Lanceley A. Recruitment, adherence, and retention of endometrial cancer survivors in a behavioural lifestyle programme: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomised pilot trial. BMJ Open 2017; 7:e018015. [PMID: 28993394 PMCID: PMC5640120 DOI: 10.1136/bmjopen-2017-018015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Healthy eating and physical activity may help endometrial cancer survivors (ECS) improve their quality of life. However, most ECS do not meet the relevant guidelines. This pilot trial aimed to test the study feasibility procedures for a definitive trial of a behavioural lifestyle programme. DESIGN AND SETTING This 24-week parallel two-arm randomised pilot trial took place in two hospitals in London, UK (April 2015-June 2016). PARTICIPANTS Sixty disease-free ECS within 3 years of diagnosis. INTERVENTIONS Participants were randomised using minimisation to receive the intervention or care as usual. The 'Shape-Up following cancer treatment' programme used self-monitoring, goal-setting, self-incentives, problem-solving and group social support for 12 hours over 8 weeks to help survivors improve their eating and physical activity. OUTCOME MEASURES The main outcome measures were recruitment, adherence, and retention rates. Further outcomes included barriers to participation and feedback on programme satisfaction. RESULTS Of the 296 potentially eligible ECS, 20% (n=60) were randomly allocated to the active intervention (n=29) or control group (n=31). Three participants in each arm were deemed ineligible after randomisation and excluded from analysis. Twenty participants (77%; 95% CI 61% to 93%) adhered to the intervention and provided generally favourable feedback. At 24 weeks, 25/26 (96%; 95% CI 89% to 100%) intervention and 24/28 (86%; 95% CI 73% to 99%) control participants completed their assessment. No intervention-related adverse events were reported. Among eligible survivors who declined study participation (n=83), inconvenience (78%; 95% CI 69% to 87%) was the most common barrier. CONCLUSIONS The trial was feasible to deliver based on the a priori feasibility criteria. Enhancing recruitment and adherence in a definitive trial will require designs that promote convenience and consider ECS-reported barriers. TRIAL REGISTRATION NUMBER NCT02433080; Pre-results. TRIAL FUNDING University College London, St. Bartholomew's Hospital Nurses League, and NIHR University College London Hospitals Biomedical Research Centre.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ranjit Manchanda
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Moscho Michalopoulou
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
| | - Matthew Burnell
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
| | - M Tish Knobf
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
- Acute Care/Health Systems Division, Yale University School of Nursing, West Haven, Connecticut, USA
| | - Anne Lanceley
- Department of Women’s Cancer, EGA Institute for Women’s Health, University College London, London, UK
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197
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Reeder-Hayes KE, Roberts MC, Henderson GE, Dees EC. Informed Consent and Decision Making Among Participants in Novel-Design Phase I Oncology Trials. J Oncol Pract 2017; 13:e863-e873. [PMID: 28837373 PMCID: PMC5640413 DOI: 10.1200/jop.2017.021303] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although phase I clinical trials are the gateway to progress in cancer therapies, this setting poses ethical challenges to ensure that patients provide consent free from misunderstandings of therapeutic intent or unrealistic expectations of benefit. The design of phase I oncology trials has evolved rapidly over time and today includes more targeted agents and combinations of experimental drugs with standard drugs, which may further complicate how patients understand phase I research participation. METHODS We conducted semistructured interviews regarding motivations, decision making, and understanding of trial purpose nested within a phase I clinical trial of a novel PI3kinase inhibitor combined with a standard oral chemotherapy in 18 participants. RESULTS Fewer than half of patients correctly identified the safety and dosing objectives. The inclusion of a targeted agent was attractive to participants and was perceived as an indicator of less toxic or more efficacious therapy, with less appreciation for added risks. The significance of a cellular drug target, without a known predictive biomarker of response, was unclear to patients. The inclusion of a standard drug in the regimen attracted patients with more treatment options than traditional first-in-human participants. Patients frequently expressed a realistic understanding of prognosis and uncertainty of benefit, but simultaneous hopes for extraordinary outcomes. CONCLUSION Novel phase I oncology trial designs may attract patients with less constrained treatment options, but the inclusion of targeted drugs and combinations including standard chemotherapies is likely to complicate understanding of safety and dosing objectives and likelihood of personal benefit for purposes of informed consent.
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Affiliation(s)
| | - Megan C. Roberts
- University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Washington, DC
| | - Gail E. Henderson
- University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Washington, DC
| | - Elizabeth C. Dees
- University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Washington, DC
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198
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Straube C, Herschbach P, Combs SE. Which Obstacles Prevent Us from Recruiting into Clinical Trials: A Survey about the Environment for Clinical Studies at a German University Hospital in a Comprehensive Cancer Center. Front Oncol 2017; 7:181. [PMID: 28894695 PMCID: PMC5581318 DOI: 10.3389/fonc.2017.00181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Prospective clinical studies are the most important tool in modern medicine. The standard in good clinical practice in clinical trials has constantly improved leading to more sophisticated protocols. Moreover, translational questions are increasingly addressed in clinical trials. Such trials must follow elaborate rules and regulations. This is accompanied by a significant increase in documentation issues which require substantial manpower. Furthermore, university-based clinical centers are interested in increasing the amount of patients treated within clinical trials, and this number has evolved to be a key quality criterion. The present study was initiated to elucidate the obstacles that limit clinical scientists in screening and recruiting for clinical trials. Methods A specific questionnaire with 28 questions was developed focusing on all aspects of clinical trial design as well as trial management. This included questions on organizational issues, medical topics as well as potential patients’ preferences and physician’s goals. The questionnaire was established to collect data anonymously on a web-based platform. The survey was conducted within the Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich; physicians of all levels (Department Chairs, attending physicians, residents, as well as study nurses, and other study-related staff) were addressed. The answers were analyzed using the Survio analyzing tool (http://www.survio.com/de/). Results We collected 42 complete sets of answers; in total 28 physicians, 11 study nurses, and 3 persons with positions in administration answered our survey. The study centers reported to participate in a range of 3–160 clinical trials with a recruitment rate of 1–80%. Main obstacles were determined: 31/42 (74%) complained about limited human resources and 22/42 (52%) reported to have a lack on technical resources, too. 30/42 (71%) consented to the answer, that the documentation effort of clinical trials is too large. A possible increase of the patients’ study participation rate up to over 20% was deemed to be possible if the described limitations could be overcome. Discussion The increasing documentation effort in clinical trials has led to a strong increase in the work load of scientific personnel. Recruiting of patients into clinical trials therefore is not only limited by patient issues, but also by the infrastructure of the centers. Especially the lack of study nurses is likely to be a major limitation. Furthermore, technical resources for time efficient and safe documentation within clinical routine as well as in clinical trials are required. By optimization of these factors, a significant increase in the amount of patients treated in clinical trials seems to be possible.
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Affiliation(s)
- Christoph Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK) - Partner Site München, Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Munich, Germany
| | - Peter Herschbach
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) - Partner Site München, Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Munich, Germany.,Klinik für psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK) - Partner Site München, Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Munich, Germany.,Department of Radiation Sciences (DRS), Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Oberschleißheim, Germany
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199
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Gruen ME, Griffith EH, Caney SMA, Rishniw M, Lascelles BDX. Attitudes of small animal practitioners toward participation in veterinary clinical trials. J Am Vet Med Assoc 2017; 250:86-97. [PMID: 28001115 DOI: 10.2460/javma.250.1.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine attitudes of small animal practitioners toward veterinary clinical trials and variables influencing their likelihood of participating in such trials. DESIGN Cross-sectional survey. SAMPLE Small animal practitioners with membership in 1 of 2 online veterinary communities (n = 163 and 652). PROCEDURES An online survey was developed for each of 2 veterinary communities, and invitations to participate were sent via email. Each survey included questions designed to collect information on the respondents' willingness to enroll their patients in clinical trials and to recommend participation to clients for their pets. RESULTS More than 80% of respondents to each survey indicated that they spend no time in clinical research. A high proportion of respondents were likely or extremely likely to recommend clinical trial participation to clients for their pets when those trials involved treatments licensed in other countries, novel treatments, respected investigators, or sponsoring by academic institutions, among other reasons. Reasons for not recommending participation included distance, time restrictions, and lack of awareness of ongoing clinical trials; 28% of respondents indicated that they did not usually learn about such clinical trials. Most respondents (79% to 92%) rated their recommendation of a trial as important to their client's willingness to participate. CONCLUSIONS AND CLINICAL RELEVANCE Participation in veterinary clinical trials by small animal practitioners and their clients and patients appeared low. Efforts should be increased to raise practitioner awareness of clinical trials for which patients might qualify. Specific elements of trial design were identified that could be modified to increase participation.
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Krieger JL, Krok-Schoen JL, Dailey PM, Palmer-Wackerly AL, Schoenberg N, Paskett ED, Dignan M. Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology. QUALITATIVE HEALTH RESEARCH 2017; 27:1146-1159. [PMID: 27179018 DOI: 10.1177/1049732316645321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Mark Dignan
- 4 University of Kentucky, Lexington, Kentucky, USA
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