1
|
Peralta G, Sánchez-Santiago B. Navigating the challenges of clinical trial professionals in the healthcare sector. Front Med (Lausanne) 2024; 11:1400585. [PMID: 38887672 PMCID: PMC11181308 DOI: 10.3389/fmed.2024.1400585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Clinical trials (CTs) are essential for medical advancements but face significant challenges, particularly in professional training and role clarity. Principal investigators, clinical research coordinators (CRCs), nurses, clinical trial pharmacists, and monitors are key players. Each faces unique challenges, such as maintaining protocol compliance, managing investigational products, and ensuring data integrity. Clinical trials' complexity and evolving nature demand specialized and ongoing training for these professionals. Addressing these challenges requires clear role delineation, continuous professional development, and supportive workplace environments to improve retention and trial outcomes. Enhanced training programs and a collaborative approach are essential for the successful conduct of clinical trials and the advancement of medical research.
Collapse
Affiliation(s)
- Galo Peralta
- Central Support Unit, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Blanca Sánchez-Santiago
- Clinical Pharmacology Service, Clinical Trials Unit, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| |
Collapse
|
2
|
Byrne EM, Pascoe M, Cooper D, Armstrong TS, Gilbert MR. Challenges and limitations of clinical trials in the adolescent and young adult CNS cancer population: A systematic review. Neurooncol Adv 2024; 6:vdad159. [PMID: 38250563 PMCID: PMC10798804 DOI: 10.1093/noajnl/vdad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The adolescent and young adult (AYA) cancer population, aged 15-39, carries significant morbidity and mortality. Despite growing recognition of unique challenges with this age group, there has been little documentation of unmet needs in their care, trial participation, and quality of life, particularly in those with primary brain tumors. Methods A systematic literature review of 4 databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies included editorials, reviews, and practice guidelines on the challenges and limitations faced by the AYA population. Papers had to address CNS tumors. Results Sixty-eight studies met the inclusion criteria. The challenges and limitations in clinical trials in the AYA population were synthesized into 11 categories: molecular heterogeneity, tumor biology, diagnostic delay, access to care, physician factors, patient factors, primary brain tumor (PBT) factors, accrual, limited trials, long term follow up, and trial design. The published papers' recommendations were categorized based on the target of the recommendation: providers, coordination of care, organizations, accrual, and trial design. The AYA cancer population was found to suffer from unique challenges and barriers to care and the construction of trials. Conclusions The AYA CNS cancer population suffers from unique challenges and barriers to care and construction of trials that make it critical to acknowledge AYAs as a distinct patient population. In addition, AYAs with primary brain tumors are underrecognized and underreported in current literature. More studies in the AYA primary brain tumor patient population are needed to improve their care and participation in trials.
Collapse
Affiliation(s)
- Emma M Byrne
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Maeve Pascoe
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Diane Cooper
- National Institute of Health Library, National Institute of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Freycon C, Lupo PJ, Witkowski L, Budd C, Foulkes WD, Goudie C. A systematic review of the prevalence of pathogenic or likely pathogenic germline variants in individuals with FOXO1 fusion-positive rhabdomyosarcoma. Pediatr Blood Cancer 2023; 70:e30651. [PMID: 37638828 DOI: 10.1002/pbc.30651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
Several cancer predisposition syndromes (CPS) are reported to predispose to rhabdomyosarcoma, most frequently in children with embryonal rhabdomyosarcoma. There are lingering questions over the role of CPS in individuals with alveolar rhabdomyosarcoma (ARMS), which are frequently driven by FOXO1 fusion oncoproteins. We conducted a systematic review to identify patients with FOXO1 fusion-positive ARMS (FP-ARMS) who underwent germline DNA sequencing. We estimated the prevalence of pathogenic/likely pathogenic (P/LP) variants in cancer predisposing genes (CPGs) and of CPSs. We included 19 publications reporting on 191 patients with FP-ARMS. P/LP variants in CPGs were identified in 26/191 (13.6%) patients, nine (4.9%) of which were associated with a CPS diagnosis. Evidence for causal associations between CPSs and FP-ARMS could not be assessed with available data from this review. Only one patient was affected with a CPS known to predispose to rhabdomyosarcoma, Li-Fraumeni syndrome. Typical CPS associations with rhabdomyosarcoma are rare, but not nonexistent, in patients with FP-ARMS. FOXO1 fusion status, alone, is insufficient for clinicians to rely on to distinguish between patients with/without CPS.
Collapse
Affiliation(s)
- Claire Freycon
- Department of Pediatrics, Division of Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Philip J Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Leora Witkowski
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Crystal Budd
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Catherine Goudie
- Department of Pediatrics, Division of Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Guilmatre A, Davous D, Sigy ADHD, Asselain B, Chevret S, Petit A. Quelles sont les pratiques en génétique des pédiatres onco-hématologues de la SFCE ? Une enquête du groupe socle éthique CONECT-AML. Bull Cancer 2022; 109:1162-1176. [DOI: 10.1016/j.bulcan.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/09/2022] [Indexed: 10/14/2022]
|
5
|
Lee BM, Kraft SA. Fostering Relationships in Pediatric Oncology Research: A Relational Ethics Approach to Clinically Integrated Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:85-88. [PMID: 33825652 DOI: 10.1080/15265161.2021.1891350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Brittany M Lee
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
| |
Collapse
|
6
|
Manda-Taylor L, Liomba A, Taylor TE, Elwell K. Barriers and Facilitators to Obtaining Informed Consent in a Critical Care Pediatric Research Ward in Southern Malawi. J Empir Res Hum Res Ethics 2020; 14:152-168. [PMID: 30866724 DOI: 10.1177/1556264619830859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Informed consent is an ethical requirement in clinical research. Obtaining informed consent is challenging in resource-constrained settings. We report results of a formative qualitative study that examined factors that facilitate and hinder informed consent for clinical research among critically ill children in Malawi. We argue that truly informed consent in a pediatric intensive care unit (PICU) is challenged by parental distress, time constraints when balancing care for critically ill patients with research-related tasks, and social hierarchies and community mistrust toward certain research procedures. We interviewed health care providers and parents of children attending a critical care unit to identify potential challenges and solicit strategies for addressing them. Providers and caregivers suggested practical solutions to enhance research participant understanding of clinical trial research, including the use of visual materials, community engagement strategies, and using patients as advocates in promoting understanding of research procedures.
Collapse
|
7
|
Kim JP, Rostami M, Roberts LW. Attitudes of Mothers Regarding Willingness to Enroll Their Children in Research. J Empir Res Hum Res Ethics 2020; 15:452-464. [PMID: 32552481 DOI: 10.1177/1556264620927583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed mothers' perspectives regarding research involvement by their children, factors that might affect perceptions of research risks, and attitudes regarding willingness to enroll children in research. Participants completed a survey on Amazon Mechanical Turk. Mothers were less inclined to enroll children in research involving procedures posing higher risk (regression coefficient = -0.51). Mothers without mental health issues with children without health issues were more sensitive to risk than mothers without mental health issues with children with health issues (estimated difference = 0.49). Mothers with mental health issues were more willing than mothers without mental health issues to enroll children in research (regression coefficient = -0.90). Among mothers with mental health issues, having a child with a health issue was associated with increased willingness to enroll in research, compared with having children without health issues (estimated difference = 0.65).
Collapse
Affiliation(s)
- Jane Paik Kim
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maryam Rostami
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | |
Collapse
|
8
|
Byrjalsen A, Stoltze UK, Castor A, Wahlberg A. Germline whole genome sequencing in pediatric oncology in Denmark-Practitioner perspectives. Mol Genet Genomic Med 2020; 8:e1276. [PMID: 32500610 PMCID: PMC7434747 DOI: 10.1002/mgg3.1276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND With the implementation of a research project providing whole genome sequencing (WGS) to all pediatric cancer patients in Denmark (2016-2019), we sought to investigate healthcare professionals' views on WGS as it was actively being implemented in pediatric oncology. METHODS Semistructured interviews were carried out with pediatric oncologists, clinical geneticists, and research coordinating nurses (N = 17), followed by content analysis of transcribed interviews. Interviews were supplemented by ethnographic observations on Danish pediatric oncology wards. Additionally, questionnaires were distributed to healthcare professionals concerning when they found it appropriate to approach families regarding WGS. The response rate was 74%. RESULTS Healthcare professionals see imbalances in doctor-patient relationship, especially the double role doctors have as clinicians and researchers. Some were concerned that it might not be possible to obtain meaningful informed consent from all families following diagnosis. Still, 94% of respondents found it acceptable to approach families during the first 4 weeks from the child's diagnosis. Views on the utility of WGS, treatment adaptation, and surveillance differed among interviewees. CONCLUSION Overall, healthcare professionals see dilemmas arising from WGS in the pediatric oncology clinic, and some advocate for further educational sessions with families and healthcare professionals. Despite concerns, healthcare professionals overwhelmingly supported early approach of families regarding WGS. Interviewees disagree on the benefits of surveillance based on genetic findings.
Collapse
Affiliation(s)
- Anna Byrjalsen
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulrik K Stoltze
- Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Castor
- Department of Paediatrics, Skaane University Hospital, Lund, Sweden
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Schröder Håkansson A, Pergert P, Abrahamsson J, Stenmarker M. Balancing values and obligations when obtaining informed consent: Healthcare professionals' experiences in Swedish paediatric oncology. Acta Paediatr 2020; 109:1040-1048. [PMID: 31520436 DOI: 10.1111/apa.15010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022]
Abstract
AIM To explore Swedish healthcare professionals' (HCPs) clinical experiences of the informed consent process (ICP) and to compare experiences between the professions. METHODS In this nationwide study six paediatric oncologists (POs) and eight research nurses (ReNs) from all Swedish paediatric oncology centres were interviewed. The material was analysed using Grounded theory, a qualitative constant comparative method. RESULTS The participants' main concern was how to fulfil research obligations without putting too much strain on a family in acute crisis, which led to the core category of balancing values and obligations of both healthcare and research. To handle the challenges the participants' struggled to safeguard the families from psychological harm, tried to adjust to the families, and gradually introduced research while building trust. The conceptual model developed in the study highlights potential consequences of this balancing act with a risk of diminishing the family's autonomy through HCPs acting authoritatively (in particular POs) or with overprotection (in particular ReNs). CONCLUSION Paediatric oncology is a research integrated healthcare environment. The HCPs need personal, professional and institutional support regarding ICP-related ethical issues, decisions and implications in this intertwined context. Furthermore, HCPs need to be aware of the potential long-term risk of developing professional moral distress.
Collapse
Affiliation(s)
- Anna Schröder Håkansson
- Institution for Clinical Sciences Department of Paediatrics the Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Paediatric Oncology Sahlgrenska University Hospital Gothenburg Sweden
| | - Pernilla Pergert
- Childhood Cancer Research Unit Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Paediatric Haematology and Oncology Children’s and Women’s Health Care Karolinska University Hospital Stockholm Sweden
| | - Jonas Abrahamsson
- Institution for Clinical Sciences Department of Paediatrics the Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Paediatric Oncology Sahlgrenska University Hospital Gothenburg Sweden
| | - Margaretha Stenmarker
- Institution for Clinical Sciences Department of Paediatrics the Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Paediatrics Futurum, Region Jönköping County Jönköping Sweden
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| |
Collapse
|
10
|
Alahmad G, Al-Kamli H, Alzahrani H. Ethical Challenges of Pediatric Cancer Care: Interviews With Nurses in Saudi Arabia. Cancer Control 2020; 27:1073274820917210. [PMID: 32292067 PMCID: PMC7160780 DOI: 10.1177/1073274820917210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Despite rapid and successful development in pediatric cancer treatment, many ethical challenges remain. These challenges have been, and continue to be, the subject of much research, but few qualitative studies have explored the views of nurses, especially in the Middle East. This study, therefore, seeks to fill a knowledge gap in this area and to better understand the concerns of nurses-particularly those in Saudi Arabia and the Middle East. Face-to-face, in-depth interviews were conducted with 17 male and female nurses working in pediatric units at 2 hospitals in Saudi Arabia to explore their views on the ethical challenges in caring for children with cancer. All interviews were recorded and transcribed, then line-by-line encoded, merged, and categorized into themes. Our results show that pediatric cancer is perceived as being "different" from other diseases, and from cancer in adults. Nurses are an integral part of the medical care team and are aware of the importance of their role, as well as the special relationships that they develop with the children. Consent is mandatory and necessary and can be signed by any parent. Assent is important when children become able to give it. Pediatric cancer is seen as a different disease by nurses for various reasons. Their roles and relationships with children and families pose many challenges. Though parental consent and child assent are essential, nurses' collaboration is important for shared decision-making. Our study paves the way for broader studies to understand the concerns of nurses and other health-care providers about treating children with pediatric cancer.
Collapse
Affiliation(s)
- Ghiath Alahmad
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Halah Al-Kamli
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Haneen Alzahrani
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| |
Collapse
|
11
|
Aurich B, Vermeulen E, Elie V, Driessens MHE, Kubiak C, Bonifazi D, Jacqz-Aigrain E. Informed consent for neonatal trials: practical points to consider and a check list. BMJ Paediatr Open 2020; 4:e000847. [PMID: 33437878 PMCID: PMC7778778 DOI: 10.1136/bmjpo-2020-000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/04/2022] Open
Abstract
Obtaining informed consent from parents of critically ill neonates can be challenging. The parental decision-making process is influenced by the severity of the child's condition, the benefit-risk balance, their emotional state and the quality of the relationship with the clinical team. Independent of local legislation, parents may prefer that consent is sought from both. Misconceptions about the absence of risks or unrealistic expectations about benefits should be openly addressed to avoid misunderstandings which may harm the relationship with the clinical team. Continuous consent can be sought where it is unclear whether the free choice of parental consent has been compromised. Obtaining informed consent is a dynamic process building on trusting relationships. It should include open and honest discussions about benefits and risks. Investigators may benefit from training in effective communication. Finally, involving parents in neonatal research including the development of the informed consent form and the process of obtaining consent should be considered standard practice.
Collapse
Affiliation(s)
- Beate Aurich
- Department of Paediatric Clinical Pharmacology and Pharmacogenetics, Robert Debré Hospital, 48 Boulevard Sérurier, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Eric Vermeulen
- Dutch patient association for rare and genetic diseases (VSOP), Soest, The Netherlands
| | - Valéry Elie
- Department of Paediatric Clinical Pharmacology and Pharmacogenetics, Robert Debré Hospital, 48 Boulevard Sérurier, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | | | - Christine Kubiak
- The European Clinical Research Infrastructure Network (ECRIN), 5-7 Rue Watt, Paris, France
| | - Donato Bonifazi
- Consorzio per le Valutazioni Biologiche e Farmacologiche, Via Nicolo Putignani, Bari, Italy.,TEDDY European Network of Excellence for Paediatric Research, Via Luigi Porta 14, Pavia, Italy
| | - Evelyne Jacqz-Aigrain
- Department of Paediatric Clinical Phramcology and Pharmacogenetics, Robert Debré Hospital, APHP, 48 Boulevard Sérurier, Paris, France.,Paris University, Paris, France
| |
Collapse
|
12
|
Dekking SAS, van der Graaf R, Zwaan CM, van Delden JJM. Voluntary Informed Consent Is Not Risk Dependent. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:33-35. [PMID: 31544669 DOI: 10.1080/15265161.2019.1572820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - C Michel Zwaan
- Erasmus Medical Centre and
- Prinses Maxima Center for Pediatric Oncology
| | | |
Collapse
|
13
|
Morain SR, Joffe S, Largent EA. When Is It Ethical for Physician-Investigators to Seek Consent From Their Own Patients? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:11-18. [PMID: 30994425 DOI: 10.1080/15265161.2019.1572811] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about "dual-role" consent reflects the view that distinct normative commitments govern physician-patient and investigator-participant relationships, and that blurring the research-care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the physician-investigator; that it can compromise the voluntariness of the patient-participant's consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force-and the ethical acceptability of dual-role consent-varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent.
Collapse
Affiliation(s)
| | - Steven Joffe
- b University of Pennsylvania Perelman School of Medicine; Children's Hospital of Philadelphia
| | - Emily A Largent
- c University of Pennsylvania Perelman School of Medicine; Leonard Davis Institute of Health Economics
| |
Collapse
|
14
|
Alahmad G. Informed Consent in Pediatric Oncology: A Systematic Review of Qualitative Literature. Cancer Control 2018; 25:1073274818773720. [PMID: 29716399 PMCID: PMC6028177 DOI: 10.1177/1073274818773720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Obtaining informed consent in pediatric cancer research can be subject to important ethical challenges because of the difficulty in distinguishing between care and research, which are interrelated. Pediatric oncologists also often conduct research, such as clinical trials, on their own patients, which may influence voluntary informed consent. This review aims to determine the ethical issues encountered in obtaining informed consent in pediatric oncology by identifying and summarizing the findings of existing qualitative studies on this topic. METHODS A systematic review of qualitative studies was conducted. Medline, Embase, CINAHL, and PubMed were searched using the following terms: (oncolog* or cancer or hematol* or haematol* or leuk* or malign* or neoplasm*) and (child* or adolescent* or minor* or young people or pediatr* or paediatr*) and ethic* or moral*) and (qualitative or interview). Other sources were also mined to identify all relevant studies. The data analysis method used was thematic analysis. RESULTS At the end of the search process, 2361 studies were identified. Duplicates were removed and irrelevant studies were excluded. After screening the full text of the remaining studies against our inclusion and exclusion criteria, 13 studies were included in the qualitative analysis. All studies were qualitative studies using semistructured and structured interviews, qualitative analysis of open-ended questions, and observation of informed consent conferences. Four themes were identified: parental comprehension of the trial and medical terms, influence of parental distress on decision-making, no offer of an alternative treatment, and influence of the doctor-parent relationship. CONCLUSION Many ethical challenges affect the informed consent process. These challenges may include a lack of parental understanding, the potential influence of treating doctors, and vulnerability because of psychological status. All of these result in parents being unable to give well-informed and voluntary consent. Researchers are encouraged to adopt a stepwise approach during the informed consent process.
Collapse
Affiliation(s)
- Ghiath Alahmad
- 1 King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
15
|
Byrjalsen A, Stoltze U, Wadt K, Hjalgrim LL, Gerdes AM, Schmiegelow K, Wahlberg A. Pediatric cancer families’ participation in whole-genome sequencing research in Denmark: Parent perspectives. Eur J Cancer Care (Engl) 2018; 27:e12877. [DOI: 10.1111/ecc.12877] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 04/04/2018] [Accepted: 06/08/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Anna Byrjalsen
- Department of Clinical Genetics; Rigshospitalet; Copenhagen Denmark
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet; Copenhagen Denmark
| | - Ulrik Stoltze
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet; Copenhagen Denmark
| | - Karin Wadt
- Department of Clinical Genetics; Rigshospitalet; Copenhagen Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet; Copenhagen Denmark
| | - Anne-Marie Gerdes
- Department of Clinical Genetics; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Medicine; University of Copenhagen; Copenhagen Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Medicine; University of Copenhagen; Copenhagen Denmark
| | - Ayo Wahlberg
- Department of Anthropology; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
16
|
van der Graaf R, Dekking SA, de Vries MC, Zwaan CM, van Delden JJ. Pediatric oncology as a Learning Health System: Ethical implications for best available treatment protocols. Learn Health Syst 2018; 2:e10052. [PMID: 31245582 PMCID: PMC6508761 DOI: 10.1002/lrh2.10052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/12/2018] [Accepted: 01/21/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pediatric oncology is often considered as a field in which research and care are highly integrated. We believe that this integration can be seen as a so-called Learning Health System, a system in which research is considered an important means to continuously improve the practice of care. In order to substantiate our assumption of pediatric oncology as an LHS, we will analyze so-called "best available treatment protocols." These protocols always contain research elements, even if themain goal of these protocols is to treat children diagnosed with cancer. METHODS We will analyze the implications for ethical review and informed consent if these protocols had to function as exponents of pediatric oncology an LHS. RESULTS An analysis of best available treatment protocols teaches us how these protocols integrate care and research and how these protocols can be seen as exponents of a system where care and research need no longer be sharply distinct practices. DISCUSSION Further intervention in the field of pediatric oncology is essential to also meet the requirements for an ethically responsible LHS. CONCLUSION Best available treatment protocols, which combine research and care, can be seen as examples of pediatric oncology as an LHS. However, in order to prevent that research elements in these protocols will be overlooked, we will have to find new ways to accommodate for the oversight of these protocols, such as multifaceted review and risk-adapted approaches. Moreover, informed consent process must be changed in order for patients to understand how care and research are integrated in these protocols.
Collapse
Affiliation(s)
- Rieke van der Graaf
- Department of Medical HumanitiesUniversity Medical Center Utrecht Julius CenterUtrechtThe Netherlands
| | - Sara A. Dekking
- Ethics Division Department of Public HealthMinistry of Health, Welfare and SportThe HagueThe Netherlands
| | - Martine C. de Vries
- Department of Medical Ethics and Health LawLeiden University Medical CenterLeidenThe Netherlands
| | - Christian Michel Zwaan
- Department of Paediatric OncologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Johannes J.M. van Delden
- Department of Medical HumanitiesUniversity Medical Center Utrecht Julius CenterUtrechtThe Netherlands
| |
Collapse
|
17
|
Badarau DO, Ruhe K, Kühne T, De Clercq E, Colita A, Elger BS, Wangmo T. Decision making in pediatric oncology: Views of parents and physicians in two European countries. AJOB Empir Bioeth 2017; 8:21-31. [PMID: 28949870 DOI: 10.1080/23294515.2016.1234519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Decision making is a highly complex task when providing care for seriously ill children. Physicians, parents, and children face many challenges when identifying and selecting from available treatment options. METHODS This qualitative interview study explored decision-making processes for children with cancer at different stages in their treatment in Switzerland and Romania. RESULTS Thematic analysis of interviews conducted with parents and oncologists identified decision making as a heterogeneous process in both countries. Various decisions were made based on availability and reasonableness of care options. In most cases, at the time of diagnosis, parents were confronted with a "choiceless choice"-that is, there was only one viable option (a standard protocol), and physicians took the lead in making decisions significant for health outcomes. Parents' and sometimes children's role increased during treatment when they had to make decisions regarding research participation and aggressive therapy or palliative care. Framing these results within the previously described Decisional Priority in Pediatric Oncology Model (DPM) highlights family's more prominent position when making elective decisions regarding quality-of-life or medical procedures, which had little effect on health outcomes. The interdependency between oncologists, parents, and children is always present. Communication, sharing of information, and engaging in discussions about preferences, values, and ultimately care goals should be decision making's foundation. CONCLUSIONS Patient participation in these processes was reported as sometimes limited, but parents and oncologists should continue to probe patients' abilities and desire to be involved in decision making. Future research should expand the DPM and explore how decisional priority and authority can be shared by oncologists with parents and even patients.
Collapse
Affiliation(s)
| | | | - Thomas Kühne
- b Department of Pediatric Oncology and Hematology , University Children's Hospital Basel
| | - Eva De Clercq
- a Institute for Biomedical Ethics, University of Basel
| | - Anca Colita
- c Department of Pediatric Hemato-oncology and Bone Marrow Transplantation , Fundeni Clinical Institute
| | | | - Tenzin Wangmo
- a Institute for Biomedical Ethics, University of Basel
| |
Collapse
|
18
|
Abstract
BACKGROUND In pediatric oncology, many oncologists invite their own patients to participate in research. Inclusion within a dependent relationship is considered to potentially compromise voluntariness of consent. Currently, it is unknown to what extent those involved in pediatric oncology experience the dependent relationship as a threat to voluntary informed consent, and what they see as safeguards to protect voluntary informed consent within a dependent relationship. AIM We performed a qualitative study among key actors in pediatric oncology to explore their experiences with the dependent relationship and voluntary informed consent. METHODS We conducted three focus groups and 25 semi-structured, in-depth interviews with pediatric oncologists, research coordinators, Research Ethics Committee members, parents of children with cancer, and adolescents with cancer. RESULTS Professionals regarded the dependent relationship both as a potential threat to and as a positive influence on voluntary decision making. Parents and adolescents did not feel as though dependency upon the oncologist influenced their decisions. They valued the involvement of their own physician in the informed consent process. The professionals suggested three strategies to protect voluntariness: emphasizing voluntariness; empowering families; involvement of an independent person. CONCLUSIONS Although the dependent relationship between pediatric oncologists, patients and parents may be problematic for voluntary informed consent, this is not necessarily the case. Moreover, the involvement of treating physicians may even have a positive impact on the informed consent process. Although we studied pediatric oncology, our results may also apply to many other fields of pediatric medicine where research and care are combined, for example, pediatric rheumatology, neurology and nephrology. Clinical trials in these fields are inevitably often designed, initiated and conducted by medical specialists closely involved in patient care.
Collapse
|