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Morgan SE, Harrison TR, Wright KO, Malova E, Deal B, Jia X. Reducing Health Disparities Among African American and Black Caribbean Patients by Improving the Communication Practices of Clinical Research Coordinators. HEALTH COMMUNICATION 2024; 39:1298-1309. [PMID: 37165558 DOI: 10.1080/10410236.2023.2211740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This manuscript focuses on the communication factors that affect the willingness of African Americans and Black Caribbean patients to participate in clinical trials and research studies. Low rates of research participation by members of communities of color have long been linked to health disparities. While there are many factors that contribute to low rates of accrual of African American and Black patients to clinical trials, a lack of attention to communication factors that enhance or inhibit the recruitment process is central to the problem. In this study, we describe results from the analysis of six focus groups (N = 31) consisting of African American (k = 3) and Black Caribbean (k = 3) participants. Our analyses focus on verbal and nonverbal communication behaviors and how they affect participants' willingness to participate in clinical trials. Specifically, when clinical research coordinators (CRCs) had a professional appearance, made the effort to explain a study in detail, made eye contact, took the time to listen and answer questions patiently, and gave the sense that the CRC was being truthful and transparent, patients felt respected and valued. Additionally, participants emphasized the importance of the process of developing and maintaining a trusting relationship between study participants and CRCs. The results of this study will be used to develop a clinical trial communication training program designed to enhance the communication skills of clinical research coordinators who discuss research participation with African American and Caribbean Black patients.
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Affiliation(s)
| | | | | | | | - Bonnie Deal
- School of Communication, University of Miami
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Hecht ML, Jayawardene W, Henderson C, Pezalla A, Flood-Grady E, Krieger JL, Frederick A, Parker M, Ables E. Developing the Opioid Rapid Response System™ for Lay Citizen Response to the Opioid Overdose Crisis: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1386-1397. [PMID: 37737966 DOI: 10.1007/s11121-023-01588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
Emergency responders face challenges in arriving timely to administer naloxone in opioid overdoses. Therefore, interest in having lay citizens administer naloxone nasal spray has emerged. These citizens, however, must be recruited and trained, and be in proximity to the overdose. This study aimed to develop the Opioid Rapid Response System (ORRS)tm to meet this need by developing a system to recruit and train citizen responders and evaluate outcomes in a randomized clinical trial. ORRS recruitment messages and training platform were developed iteratively and then outcomes for each were evaluated in a randomized, unblinded two-arm waitlist-controlled trial. ORRS was field tested in 5 Indiana counties, recruiting adult citizen responders (age 18 or older) who did not self-identity as a certified first responder. Participants were recruited using either personal or communal messages and then randomly assigned to online naloxone training and waitlisted-control conditions. Pre- and post-surveys were administered online to measure the exposure to recruitment messages and training effects on knowledge of opioid overdose, confidence responding, concerns about responding, and intent to respond. Of the 220 randomized participants (114 training, 106 waitlisted-control), 140 were analyzed (59 training, 81 waitlisted-control). Recruited participants more frequently identified with communal appeal than with the personal appeal (chi-square = 53.5; p < 0.0001). Between-group differences for intervention effects were significant for knowledge of overdose signs (Cohen's d = 1.17), knowledge of overdose management (d = 1.72), self-efficacy (d = 1.39), and concerns (d = 1.31), but not for intent (d = 0.17), which suffered from a ceiling effect. ORRS provides stronger support for efficacy than that reported for other training interventions and the digital modality eases rapid dissemination.Trial Registration: NCT04589676.
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Affiliation(s)
| | - Wasantha Jayawardene
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA.
| | - Cris Henderson
- Prevention Insights, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | | | - Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Amy Frederick
- Prevention Insights, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Maria Parker
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Erin Ables
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
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Julian McFarlane S, Occa A, Peng W, Awonuga O, Morgan SE. Community-Based Participatory Research (CBPR) to Enhance Participation of Racial/Ethnic Minorities in Clinical Trials: A 10-Year Systematic Review. HEALTH COMMUNICATION 2022; 37:1075-1092. [PMID: 34420460 DOI: 10.1080/10410236.2021.1943978] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There has not been a significant improvement in the rate of clinical trial accrual in more than 20 years. Worse, the challenge of inadequate representation among racial and ethnic minorities also persists, deepening disparities in health. Community-Based Participatory Research (CBPR) is a participatory communication method that centers on effective dialogue between researchers and community stakeholders with the goal of creating an equitable partnership for health and social change. The objective of the current study was to provide an update since a systematic review in 2012, on the current status of the empirical research, with a particular focus on the elements of CBPR methods used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Our systematic review found a large increase in the number of CBPR related studies and studies related to racial and ethnic representation in research. More than 85% of studies employing CBPR methods saw statistically positive outcomes. Specifically, the elements of CBPR that are associated with these positive outcomes include community partner participation in (1) a study advisory committee, (2) data collection, (3) the development of interventions, and (4) participant recruitment. However, the results of our study indicate that researchers need to be more transparent about the extent of community participation as well as more thoroughly and accurately describe the nature of the partnership with members of minority communities in order to build upon the scientific literature on community-engaged methods.
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Affiliation(s)
| | - Aurora Occa
- Department of Communication, University of Kentucky
| | - Wei Peng
- Murrow College of Communication, Washington State University
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McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review. Clin Trials 2022; 19:464-476. [PMID: 35586873 DOI: 10.1177/17407745221090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Claire E Nightingale
- Monash Rural Health, Monash University, Bendigo, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, VIC, Australia.,Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Eli Ristevski
- Monash Rural Health, Monash University, Warragul, VIC, Australia
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Rodriguez L, Murray-Krezan C, Regino L, Tellez M, Vasquez C, Sandoval V, Perez Rodriguez D, Pedigo B, Page-Reeves J. A Study of a Culturally and Contextually Situated Multimedia Approach to Recruit a Hard-to-Reach Spanish-Speaking Population for a Randomized Control Trial (RCT). J Empir Res Hum Res Ethics 2022; 17:461-470. [PMID: 35585705 DOI: 10.1177/15562646221102682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Study designs involving randomization can be difficult to communicate to participants, especially those with low literacy. The literature on strategies to explain research concepts is limited, especially for non-English speakers. We measured the effectiveness of a culturally and contextually situated multimedia approach to recruit a cohort of 60 female Mexican immigrants (FMI) to a randomized control trial (RCT) to reduce social isolation and depression. This strategy was designed to explain the concept of randomization, explain what participating in the research study entailed, and ensure informed consent. Potential participants viewed a presentation explaining the study and a video including animation with voice-over explaining the concept of randomization. We administered a pre/post survey. Respondents (N = 59) reported an increase in their understanding of randomization, intention to enroll, and attitude towards participating in research. We conclude that a culturally and contextually situated multimedia approach is an effective model when recruiting underrepresented populations with low literacy for RCTs.
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Affiliation(s)
- Larimar Rodriguez
- 12288University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Lidia Regino
- Office for Community Health, University of New Mexico, Albuquerque, NM, USA
| | - Maria Tellez
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | | | - Virginia Sandoval
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | | | - Blanca Pedigo
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | - Janet Page-Reeves
- Office for Community Health, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
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Gray TF, Allgood SJ, Nolan MT, Gallo JJ, Han HR, Clayman ML, Budhathoki C, Lansey DG, Wenzel J. "It All Depends": Patient and Decision Partner Experiences in Cancer Clinical Trial Decision-Making. QUALITATIVE HEALTH RESEARCH 2022; 32:887-901. [PMID: 35343318 DOI: 10.1177/10497323221083355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the supporting role of families and friends has been widely recognized in cancer care, little data exist on how they influence patients' decisions regarding clinical trial participation, accounting for patients' decisional preferences. The goal of our study was to examine the process of clinical trial decision-making from the perspective of adults with cancer and their decision partners. Semi-structured interviews were conducted with 12 patients and 12 decision partners-family and friends engaged in the medical decision-making. Themes included: (1) having the ability and confidence to make decisions; (2) gaining insight about clinical trials; (3) trusting someone in the process; and (4) realizing readiness and context. Our findings will enhance understanding of how patients make clinical trial decisions based on decisional preferences from the perspectives of patients and decision partners. The findings may also help to increase clinician awareness and inclusion of decision partners in conversations regarding clinical trials.
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Affiliation(s)
- Tamryn F Gray
- 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Marie T Nolan
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Joseph J Gallo
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marla L Clayman
- 560937Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Bedford, MA, USA
| | | | - Dina G Lansey
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Wenzel
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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Mao B, Morgan SE, Peng W, McFarlane SJ, Occa A, Grinfeder G, Byrne MM. What Motivates You to Share? The Effect of Interactive Tailored Information Aids on Information Sharing about Clinical Trials. HEALTH COMMUNICATION 2021; 36:1388-1396. [PMID: 32345059 PMCID: PMC9680906 DOI: 10.1080/10410236.2020.1754588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Cancer patients learn about research studies outside of the clinical environment, including websites, print and online advertisements, and interpersonal interactions. When cancer patients share credible information about clinical trials, they also frequently help clarify misunderstandings that may exist in their social networks. The present study investigated how an interactive tailored information aid on clinical trial participation motivated patients' information sharing behaviors. In this study of 312 cancer patients and survivors, an interactive tailored information aid improved patients' likelihood of sharing online and offline information more than a non-interactive tool. Information sharing was directly predicted by cognitive absorption and perceived visual informativeness. In addition, perceived utility and ease of use indirectly impact information sharing positively through the antecedent factors of user engagement and design esthetics. Education level further moderated this effect; information sharing was higher among patients with more education. The implications of these findings are discussed and recommendations for future research are provided.
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Affiliation(s)
| | | | - Wei Peng
- School of Communication, University of Miami
| | | | - Aurora Occa
- Department of Communication, University of Kentucky
| | | | - Margaret M Byrne
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
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Occa A, Morgan SE, Peng W, Mao B, McFarlane SJ, Grinfeder K, Byrne M. Untangling interactivity's effects: The role of cognitive absorption, perceived visual informativeness, and cancer information overload. PATIENT EDUCATION AND COUNSELING 2021; 104:1059-1065. [PMID: 33969824 PMCID: PMC8110950 DOI: 10.1016/j.pec.2020.10.007] [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] [Received: 02/27/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Learning about clinical trials is as stressful and challenging for cancer patients as it is for the clinical staff who provide education to patients. Information aids (IAs) can support both discussions and patients' decision-making, especially when IAs offer interactive features that provide information based on individuals' needs and experiences. However, it is not clear which factors contribute to interactive IAs' effectiveness. METHODS An experiment with cancer patients and survivors (n = 313) compared the effects of two IAs about clinical trial participation: one with modality (i.e. website/technological) interactivity only and one with both modality and message interactivity (i.e. provides information contingent on individual users' information needs). RESULTS The IA with both modality and message interactivity features elicited the higher perceived visual informativeness (PVI) and cognitive absorption (CA) scores. The model supports the moderating role of PVI and cancer information overload (CIO), and the mediating role of CA. CONCLUSION The IA with both modality and message interactivity better supported individuals' decision-making and improved attitudes and knowledge scores. CIO was experienced more by participants using the modality interactivity-only IA. PRACTICE IMPLICATIONS Message interactivity may simplify individuals' cognitive processes. IAs about clinical trial participation should include both message and modality interactivity.
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Affiliation(s)
- Aurora Occa
- Department of Communication, University of Kentucky, United States.
| | - Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, United States
| | - Wei Peng
- The Edward R. Murrow College of Communication, Washington State University, United States
| | - Bingjing Mao
- Department of Communication Studies, University of Miami, Coral Gables, FL, 33146, United States
| | - Soroya Julian McFarlane
- Department of Communication Studies, University of Georgia, Athens, GA, 30602, United States
| | - Kim Grinfeder
- Department of Interactive Media, University of Miami, Coral Gables, FL, 33146, United States
| | - Margaret Byrne
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, 33612, United States
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Rix J, Branney J, Breen AC, Sewell P, Docherty S. Stakeholder involvement in the development of trial material for a clinical trial. Health Expect 2021; 24:399-410. [PMID: 33316128 PMCID: PMC8077147 DOI: 10.1111/hex.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stakeholder involvement includes not just patients and public, but also those delivering treatment for example clinicians and students. Each stakeholder brings unique experiences to the process. The aim of this stakeholder exercise was to explore readability and understanding of the trial material for the future trial to be conducted by the authors: Biomechanical Effects of Manual Therapy-A Feasibility Study. DESIGN Volunteers from identified stakeholder groups were provided with trial material which included the information sheet, consent form, questionnaires and home management booklet. They provided feedback on content (readability, understanding) and style (font, layout). An additional document was provided with genres of pictures to choose the most appropriate style to be used in the booklet. Readability formulas were used to calculate reading age before and after feedback to objectively measure ease of reading. RESULTS The public group provided a layperson's perspective to clarify the information sheet for patients, whereas practitioner and intern groups indicated where information could be clarified. The reading age of all documentation decreased following feedback; however, templated sections of the documentation did not. The majority (87%) of volunteers chose coloured classic cartoons for the booklet. CONCLUSION This process highlighted the importance of involving different stakeholder groups in the development of research materials as each group made a unique contribution. Readability and understanding of the trial material were improved, feeding back into the consent process contributing towards fully informed consent. PATIENT OR PUBLIC CONTRIBUTION Public helped develop materials for a future trial but not with manuscript preparation.
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Affiliation(s)
- Jacqueline Rix
- Department of Design and EngineeringFaculty of Science and TechnologyBournemouth UniversityPooleUK
- Centre for Biomechanics ResearchAECC University CollegeBournemouthUK
| | - Jonathan Branney
- Department of Nursing ScienceFaculty of Health and Social ScienceBournemouth UniversityPooleUK
| | | | - Philip Sewell
- Department of Design and EngineeringFaculty of Science and TechnologyBournemouth UniversityPooleUK
| | - Sharon Docherty
- Department of Medical Science & Public HealthFaculty of Health & Social SciencesBournemouth UniversityPooleUK
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Unger JM, Hershman DL, Till C, Minasian LM, Osarogiagbon RU, Fleury ME, Vaidya R. "When Offered to Participate": A Systematic Review and Meta-Analysis of Patient Agreement to Participate in Cancer Clinical Trials. J Natl Cancer Inst 2021; 113:244-257. [PMID: 33022716 PMCID: PMC7936064 DOI: 10.1093/jnci/djaa155] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient participation in clinical trials is vital for knowledge advancement and outcomes improvement. Few adult cancer patients participate in trials. Although patient. decision-making about trial participation has been frequently examined, the participation rate for patients actually offered a trial is unknown. METHODS A systematic review and meta-analysis using 3 major search engines was undertaken. We identified studies from January 1, 2000, to January 1, 2020, that examined clinical trial participation in the United States. Studies must have specified the numbers of patients offered a trial and the number enrolled. A random effects model of proportions was used. All statistical tests were 2-sided. RESULTS We identified 35 studies (30 about treatment trials and 5 about cancer control trials) among which 9759 patients were offered trial participation. Overall, 55.0% (95% confidence interval [CI] = 49.4% to 60.5%) of patients agreed to enroll. Participation rates did not differ between treatment (55.0%, 95% CI = 48.9% to 60.9%) and cancer control trials (55.3%, 95% CI = 38.9% to 71.1%; P = .98). Black patients participated at similar rates (58.4%, 95% CI = 46.8% to 69.7%) compared with White patients (55.1%, 95% CI = 44.3% to 65.6%; P = .88). The main reasons for nonparticipation were treatment choice or lack of interest. CONCLUSIONS More than half of all cancer patients offered a clinical trial do participate. These findings upend several conventional beliefs about cancer clinical trial participation, including that Black patients are less likely to agree to participate and that patient decision-making is the primary barrier to participation. Policies and interventions to improve clinical trial participation should focus more on modifiable systemic structural and clinical barriers, such as improving access to available trials and broadening eligibility criteria.
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Affiliation(s)
- Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | | | - Cathee Till
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - Lori M Minasian
- National Cancer Institute, Division of Cancer Prevention, Rockville, MD, USA
| | | | - Mark E Fleury
- American Cancer Society Cancer Action Network Inc, Washington, DC, USA
| | - Riha Vaidya
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
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Natale P, Saglimbene V, Ruospo M, Gonzalez AM, Strippoli GF, Scholes-Robertson N, Guha C, Craig JC, Teixeira-Pinto A, Snelling T, Tong A. Transparency, trust and minimizing burden to increase recruitment and retention in trials: a systematic review. J Clin Epidemiol 2021; 134:35-51. [PMID: 33515656 DOI: 10.1016/j.jclinepi.2021.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe patient perspectives on recruitment and retention in clinical trials. STUDY DESIGN AND SETTING Systematic review of qualitative studies that reported the perspective of adult patients with any health condition who accepted or declined to participate in clinical trials. RESULTS Sixty-three articles involving 1681 adult patients were included. Six themes were identified. Four themes reflected barriers: ambiguity of context and benefit - patients were unaware of the research question and felt pressured in making decisions; lacking awareness of opportunities - some believed health professionals obscured trials opportunities, or felt confused because of language barriers; wary of added burden - patients were without capacity because of sickness or competing priorities; and skepticism, fear and mistrust - patients feared loss of privacy, were suspicious of doctor's motivation, afraid of being a guinea pig, and disengaged from not knowing outcomes. Two themes captured facilitators: building confidence - patients hoped for better treatment, were supported from family members and trusted medical staff; and social gains and belonging to the community - altruism, a sense of belonging and peer encouragement motivated participation in trials. CONCLUSION Improving the visibility and transparency of trials, supporting informed decision making, minimizing burden, and ensuring confidence and trust may improve patient participation in trials.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | - Valeria Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marinella Ruospo
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Giovanni Fm Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Tom Snelling
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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13
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Viljoen B, Chambers SK, Dunn J, Ralph N, March S. Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies. J Multidiscip Healthc 2020; 13:1257-1281. [PMID: 33149597 PMCID: PMC7603415 DOI: 10.2147/jmdh.s266281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.
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Affiliation(s)
- Bianca Viljoen
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Suzanne K Chambers
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeff Dunn
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Nicholas Ralph
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Sonja March
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Brisbane, Australia
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14
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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.
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15
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Peng W, Occa A, McFarlane SJ, Morgan SE. A Content Analysis of the Discussions about Clinical Trials on A Cancer-dedicated Online Forum. JOURNAL OF HEALTH COMMUNICATION 2019; 24:912-922. [PMID: 31709917 DOI: 10.1080/10810730.2019.1688895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Enrollment rates of cancer clinical trials remain low, affecting the delivery of effective medical treatments. Recent research has documented common factors affecting trial participation, but to improve these efforts more studies are needed to further understand specific concerns and issues of potential participants in multiple contexts. Forums and other online peer-to-peer health communities are crucial to the coping and survivorship of cancer patients. Online health communities will offer valuable information to understand how patients discuss perceptions, motivations, and challenges associated with clinical trial participation, and to understand how patients provide support to each other. The present study conducted a content analysis of 270 posts shared by 154 unique users between August 2017 and January 2018 on a popular online breast cancer forum. The analysis identifies common characteristics of patient users, salient post themes, perceived barriers, emotions, and misconceptions regarding clinical trial participation. The study findings are generally consistent with previous studies but provide in-depth insights into online support between cancer patients about clinical trial participation. Implications for practice and future research are also discussed.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida, USA
| | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky, USA
| | | | - Susan E Morgan
- School of Communication, University of Miami, Coral Gables, Florida, USA
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16
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Occa A, Morgan SE. Animations about Clinical Trial Participation for Cancer Patients and Survivors. JOURNAL OF HEALTH COMMUNICATION 2019; 24:749-760. [PMID: 31543072 DOI: 10.1080/10810730.2019.1668089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Communicating about clinical trials and medical research is challenging. An appropriate communication is essential to reduce some of the barriers associated with poor patients' enrollment in clinical trials and with patients' uninformed consent or uninformed refusal. An experiment was conducted to assess the effects of educational animations compared to brochures with and without visuals, and with the materials currently used by the NIH. These materials focused on explaining placebos, randomization, the steps necessary to enroll in a clinical trial, and how and by who patients' protection is ensured. A total of 1194 cancer patients and survivors completed this 4 by 4 experiment through a Qualtrics panel. The findings showed that animations improved participants knowledge about and attitudes toward clinical trials and were more effective than brochures presenting information from the NIH, especially for those individuals with low motivation and low ability to comprehend health-related information. Several evidence-based theoretical explanations of the functioning of animations are provided.
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Affiliation(s)
- Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky, USA
| | - Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
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17
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Peng W, Morgan SE, Mao B, McFarlane SJ, Occa A, Grinfeder G, Byrne MM. Ready to Make A Decision: A Model of Informational Aids to Improve Informed Participation in Clinical Trial Research. JOURNAL OF HEALTH COMMUNICATION 2019; 24:865-877. [PMID: 31663824 PMCID: PMC9617566 DOI: 10.1080/10810730.2019.1680773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Enrollment rates for cancer clinical trials remain low, affecting the generalizability of new treatments. Research shows that many patients face significant challenges in understanding basic clinical trial vocabulary and making informed decisions about participation. Informational aids (IA) are developed to address these challenges and support decision making of cancer clinical trial participation. The present study proposed and tested a structural path model to explain the efficacy of three (i.e., interactive, non-interactive, non-cancer control) IAs. The results revealed that clinical trial participation intention was associated with attitudes and social constructs (i.e., social norm, social sharing, and cues to action). Ease of use, rather than knowledge, was the primary communication feature of IA that influenced the outcome variables. The path relations linking messages features, mediators, and outcome variables were different across all three IAs. The results therefore provide theoretical and practical implications for the use and development of IAs to support clinical trial accrual.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida
| | - Susan E. Morgan
- School of Communication, University of Miami, Coral Gables, Florida
| | - Bingjing Mao
- School of Communication, University of Miami, Coral Gables, Florida
| | | | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky
| | - Gilles Grinfeder
- School of Communication, University of Miami, Coral Gables, Florida
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18
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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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19
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Assessing informed consent in an opioid relapse prevention study with adults under current or recent criminal justice supervision. J Subst Abuse Treat 2017; 81:66-72. [PMID: 28847457 DOI: 10.1016/j.jsat.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/18/2017] [Accepted: 07/31/2017] [Indexed: 11/23/2022]
Abstract
Concerns persist that individuals with substance use disorders who are under community criminal justice supervision experience circumstances that might compromise their provision of valid, informed consent for research participation. These concerns include the possibilities that desire to obtain access to treatment might lead individuals to ignore important information about research participation, including information about risks, or that cognitive impairment associated with substance use might interfere with attending to important information. We report results from a consent quiz (CQ) administered in a multisite randomized clinical trial of long-acting naltrexone to prevent relapse to opioid use disorder among adults under community criminal justice supervision-a treatment option difficult to access by this population of individuals. Participants were required to answer all 11 items correctly before randomization. On average, participants answered 9.8 items correctly (89%) at baseline first attempt (n=306). At week 21 (n=212), participants scored 87% (9.5 items correct) without review. Performance was equivalent to, or better than, published results from other populations on a basic consent quiz instrument across multiple content domains. The consent quiz is an efficient method to screen for adequate knowledge of consent information as part of the informed consent process. Clinical researchers who are concerned about these issues should consider using a consent quiz with corrected feedback to enhance the informed consent process. Overall, while primarily useful as an educational tool, employing a CQ as part of the gateway to participation in research may be particularly important as the field continues to advance and tests novel experimental treatments with significant risks and uncertain potential for benefit.
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20
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Young A, Rogers K, Davies L, Pilling M, Lovell K, Pilling S, Belk R, Shields G, Dodds C, Campbell M, Nassimi-Green C, Buck D, Oram R. Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundImproving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.Objectives(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.DesignA mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.SettingsIAPT service providers (NHS and private); the Deaf community.ParticipantsDeaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).InterventionsIAPT at steps 2 and 3.Main outcome measuresReliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.Data sourcesIAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.ResultsRandomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.LimitationsThe small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.ConclusionsThere is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.Future workA prospective observational study for definitive results is justified.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alys Young
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Rogers
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Mark Pilling
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Steve Pilling
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Rachel Belk
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Claire Dodds
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Malcolm Campbell
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Catherine Nassimi-Green
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Rosemary Oram
- Division of Nursing, Midwifery and Social Work, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
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21
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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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22
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Burnett C, Bullock L, Collins CA, Hauser L. Evaluation of a Clinical Cancer Trial Research Training Workshop: Helping Nurses Build Capacity in Southwest Virginia. Public Health Nurs 2016; 33:565-572. [PMID: 27686780 DOI: 10.1111/phn.12295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Residents of Southwest Virginia (SWVA) face significant barriers in accessing the most advanced forms of cancer care, cancer risk reduction, and clinical trials involvement. A collaboration between the University of Virginia (UVA) Cancer Center and UVA School of Nursing was forged with oncology caregivers in this region to build community capacity to support Cancer Clinical trials (CCT) by strengthening the workforce, and thus improving health outcomes for this underserved region of Appalachia. The UVA School of Nursing designed an educational workshop focusing on the basics of CCT to facilitate the development of a skilled nursing workforce in the SWVA region that could provide care to patients on protocol and/or to encourage residents to participate in trials. The goal of the workshop was to offer a CCT training session for oncology nurses that fostered the knowledge and skills necessary to facilitate and support CCT infrastructure across this high-risk region. This evaluation reports the learning outcomes of the CCT training on 32 nurse participants from SWVA. Evaluations of the training program showed high rates of satisfaction, increased comfort level with CCTs, and increased knowledge and attitude toward CCTs. These findings provide information about a curriculum that could be useful in educating other oncology nurses and student nurses how to care for patients who may be enrolled in a clinical trial. Nurses can also be advocates for participation in clinical trials once they have the knowledge and are comfortable in their own understanding of a trial's usefulness. Educating the nursing workforce is an essential component of building capacity and infrastructure to support clinical trials research.
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Affiliation(s)
- Camille Burnett
- Center for Health Policy, University of Virginia School of Nursing, Charlottesville, Virginia
| | - Linda Bullock
- School of Nursing, University of Virginia, Charlottesville, Virginia
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