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Hoda W, Pandey K. Advancing Evidence-based Palliative Care Research: Navigating Challenges and Proposing Solutions. Indian J Palliat Care 2024; 30:89-92. [PMID: 38633675 PMCID: PMC11021051 DOI: 10.25259/ijpc_243_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/16/2023] [Indexed: 04/19/2024] Open
Abstract
Amid the increasing demand for palliative care, driven by demographic shifts and medical progress, evidence-based practices face obstacles due to limited research. Complex patient conditions and ethical considerations challenge traditional methodologies, while the absence of comprehensive clinical trials hinders innovative interventions. Empowering practitioners with research skills and establishing a palliative care research network are efforts aimed at bridging these gaps. It is important to emphasise that these initiatives collectively aspire to enhance evidence-based practices, ensuring quality care for individuals facing severe illnesses.
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Affiliation(s)
- Wasimul Hoda
- Department of Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Khushboo Pandey
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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2
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Meyer C, Scarinci N, Lind C, Tulloch K, Atkins J, Hickson L. Implementation science challenges: hearing care professionals identify barriers to clinical research. Int J Audiol 2024; 63:63-68. [PMID: 36384381 DOI: 10.1080/14992027.2022.2142162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Conducting research in clinical settings is challenging. The aim of this study was to increase our understanding of hearing care professionals' perceptions of barriers to participating in such research. DESIGN A modified group concept mapping approach was used to gain anonymous responses from 124 hearing care professionals to the statement: "One reason why it is hard to conduct intervention research studies in my centre/practice is….". Participants were asked for reasons other than 'time' as this is universally reported as a barrier to clinical research. RESULTS A total of 107 distinct reasons were provided by participants and these were sorted into 5 clusters: "Competing demands/pressures" (18 statements), "Not a priority for management/organisation" (14 statements), "Lack of opportunity/support" (19 statements), "Clinician's knowledge, confidence, and beliefs" (24 statements), and "Recruitment/adherence to protocols is challenging" (32 statements). Identified barriers were generally similar to those reported in other healthcare settings, with unique barriers being those associated with a fear of scrutiny and lack of trust in the "academic elite". CONCLUSION Findings highlight the importance of researchers, clinicians, and clinic managers working together at all stages of the research process in order for clinical research to be successful.
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Affiliation(s)
- Carly Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Christopher Lind
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Kristen Tulloch
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, Australia
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Moreton Bay, Petrie, Australia
| | - Jenny Atkins
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, Australia
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3
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van Esch HJ, Stoppelenburg A, van Zuylen L, van der Rijt CC, van der Heide A. When a dying patient is asked to participate in a double-blind, placebo-controlled clinical trial on symptom control: The decision-making process and experiences of relatives. Palliat Med 2022; 36:1552-1558. [PMID: 36503315 PMCID: PMC9749009 DOI: 10.1177/02692163221127557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Placebo-controlled trials can provide evidence to inform end-of-life care, but it is contested whether asking dying patients to participate in such trials is morally justifiable. To investigate the experiences of these patients is even more complex. Therefore, proxy assessments by relatives can be a good alternative. AIM To explore the experience of participating in a placebo-controlled trial at the end of life from the perspective of bereaved relatives. DESIGN Mixed-method study, including questionnaires and interviews. SETTING/PARTICIPANTS The SILENCE study was a randomized, double-blind, placebo-controlled trial on the efficacy of scopolamine butylbromide to prevent death rattle. The study was performed in six inpatient hospice facilities. Patients were asked to participate at admission in the hospice. Three months after the death of the patient, bereaved relatives were invited to fill in a questionnaire and to participate in an interview. One hundred four questionnaires were completed and 17 relatives were interviewed. RESULTS Fourteen percent of the relatives participating in the questionnaire study considered the participation of their loved one in research a bit burdensome and 10% considered it a bit stressful. Seventeen percent thought that it was a bit burdensome for the patient. Eighty-three percent considered participation in this type of research (very) valuable. The in-depth interviews showed that patients and relatives jointly decided about participation in this double-blind placebo-controlled medication trial. Relatives generally respected and felt proud about patients' decision to participate. CONCLUSION The large majority of bereaved relatives experienced the participation of their dying love one in this RCT as acceptable and valuable.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Laurens Cadenza, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Centrum Amsterdam, Amsterdam, The Netherlands
| | - Carin Cd van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van Esch HJ, Prins SD, van de Vathorst S, van der Rijt CCD, van der Heide A, van Zuylen L. Reflections on Including Patients in a Randomized Placebo-Controlled Multicentre Trial in the Dying Phase - the SILENCE Study. J Pain Symptom Manage 2022; 63:e545-e552. [PMID: 34954069 DOI: 10.1016/j.jpainsymman.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
A need exists for studies investigating symptom relief at the end of life. Randomised controlled trials (RCTs) are the gold standard for demonstrating efficacy of medication, but they are difficult to perform at the end of life due to barriers such as the vulnerability of patients, and gatekeeping by healthcare professionals. We analyzed and reflected on recruitment, participation, and strategies used in an RCT at the end of life. The SILENCE study, performed in six inpatient hospice facilities, was a placebo-controlled trial to study the effect of ScopolamIne butyLbromidE giveN prophylactiCally for dEath rattle in dying patients. We addressed patients' vulnerability by using an advance consent procedure, and potential gatekeeping by extensive training of health care professionals and the appointment of hospice doctors as daily responsible researchers. In almost three years, 1097 patients were admitted of whom 626 were eligible at first assessment. Of these, 119 (19%) dropped out because of physical deterioration before they could be informed about the study (44) or sign informed consent (75). Twenty-five (4%) patients were not asked to participate. In 24 cases (4%), relatives advised against the patient participating. Overall, 229 patients (37%) gave informed consent to participate. The vulnerability of patients was the most important barrier in this medication study at the end of life. Gatekeeping by HCPs and relatives occurred in a small number of patients. The robust design and applied strategies to facilitate patient recruitment in this study resulted in a successful study with sufficient participants.
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Affiliation(s)
- Harriëtte J van Esch
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Laurens Cadenza, Oosterhagen 239, 3078 CL Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Sanne D Prins
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Suzanne van de Vathorst
- Department of Medical ethics,philosophy and history, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC, Amsterdam University Medical Centers, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands
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5
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van Esch HJ, van Zuylen L, van der Rijt CCD. Prophylactic Scopolamine Butylbromide and Death Rattle in Patients at the End of Life-Reply. JAMA 2022; 327:285-286. [PMID: 35040890 DOI: 10.1001/jama.2021.21863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Harriette J van Esch
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
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Hale A, Barton B, Serino-Cipoletta J, Sheldon Y, Vessey JA. Direct care nurses' perceptions of their roles in clinical research: An integrated review of the literature. J Nurs Scholarsh 2021; 54:104-116. [PMID: 34811882 DOI: 10.1111/jnu.12704] [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: 10/30/2020] [Revised: 05/06/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To review the extant literature relevant to perceptions by direct care nurses toward clinical research endeavors. DESIGN An integrative review guided by the socioecological model was conducted. METHODS Five databases were searched to identify relevant peer-reviewed articles; there was no limitation on publication date. FINDINGS The final sample (N = 9) was systematically appraised. Numerous barriers to direct care nurses' ability to perform study activities on clinical research trials were encountered at all levels: (1) personal-comprehension, education, and training; (2) interpersonal-communication issues within or from the study team, failure to advocate for the patient; (3) organizational-lack of leadership support, knowledge, and time; and (4) community-insufficient guidance and oversight by research-governing bodies. CONCLUSIONS Direct care nurses report numerous barriers to completing protocol-administered activities for their patients participating in clinical research. A dearth of robust research exists in describing the reasons for, or persistence of, barriers faced by direct care nurses to assisting with research, and there have been little to no interventions to address them. CLINICAL RELEVANCE As translational research evolves and becomes more complex, there is the need to ensure both the care of clinical research participants and the integrity of the research. Direct care nurses are critical to this endeavor, and potential barriers they face may have significant ramifications for the research enterprise. Recognition of these barriers and eventual interventions designed to address them are needed.
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Affiliation(s)
- Andrea Hale
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Brenda Barton
- Clinical Research Operations Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Yvonne Sheldon
- Department of Pediatric Newborn Medicine, , Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Judith A Vessey
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA.,Pediatric Medical Services, Boston Children's Hospital, Boston, Massachusetts, USA
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Daniels N, Gillen P, Casson K. Practitioner Engagement by Academic Researchers: A Scoping Review of Nursing, Midwifery, and Therapy Professions Literature. Res Theory Nurs Pract 2021; 34:85-128. [PMID: 32457119 DOI: 10.1891/rtnp-d-18-00125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Engagement of frontline practitioners by academic researchers in the research process is believed to afford benefits toward closing the research practice gap. However, little is known about if and how academic researchers engage nurses, midwives, or therapists in research activities or if evidence supports these claims of positive impact. METHOD A scoping review was undertaken using the Arksey and O'Malley (2005) framework to identify the extent to which this phenomenon has been considered in the literature. RESULTS An iterative search carried out in CINAHL, Pubmed, Medline, and Embase retrieved 32 relevant papers published 2000 to 2017, with the majority from the last 2-years. Retained papers described or evaluated active engagement of a practitioner from nursing, midwifery, and therapy disciplines in at least one stage of a research project other than as a study participant. Engagement most often took place in one research activity with few examples of engagement throughout the research process. Limited use of theory and variations in terms used to describe practitioner engagement by researchers was observed. Subjective perspectives of practitioners' experiences and a focus on challenges and benefits were the most prominently reported outcomes. Few attempts were found to establish effects which could support claims that practitioner engagement can enhance the use of findings or impact health outcomes. CONCLUSION It is recommended that a culture of practitioner engagement is cultivated by developing guiding theory, establishing consistent terminology, and building an evidence base through empirical evaluations which provide objective data to support claims that this activity can positively influence the research practice gap.
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Affiliation(s)
- Nicola Daniels
- School of Nursing, Ulster University, Belfast, Northern Ireland, UK
| | - Patricia Gillen
- School of Nursing, Ulster University, Belfast, Northern Ireland, UK
| | - Karen Casson
- School of Nursing, Ulster University, Belfast, Northern Ireland, UK
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Watson J, Coleman E, Jackson C, Bell K, Maynard C, Hickson L, Forster A, Fairhurst C, Hewitt C, Gardner R, Iley K, Gailey L, Thyer NJ. Randomised controlled feasibility trial of an active communication education programme plus hearing aid provision versus hearing aid provision alone (ACE To HEAR). BMJ Open 2021; 11:e043364. [PMID: 33827834 PMCID: PMC8031014 DOI: 10.1136/bmjopen-2020-043364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish the acceptability and feasibility of delivering the Active Communication Education (ACE) programme to increase quality of life through improving communication and hearing aid use in the UK National Health Service. DESIGN Randomised controlled, open feasibility trial with embedded economic and process evaluations. SETTING Audiology departments in two hospitals in two UK cities. PARTICIPANTS Twelve hearing aid users aged 18 years or over who reported moderate or less than moderate benefit from their new hearing aid. INTERVENTIONS Consenting participants (along with a significant other) were to be randomised by a remote, centralised randomisation service in groups to ACE plus treatment-as-usual (intervention group) or treatment-as-usual only (control group). PRIMARY OUTCOME MEASURES The primary outcomes were related to feasibility: recruitment, retention, treatment adherence and acceptability to participants and fidelity of treatment delivery. SECONDARY OUTCOME MEASURES International Outcomes Inventory for Hearing Aids, Self-Assessment of Communication, EQ-5D-5L and Short-Form 36. Blinding of the participants and facilitator was not possible. RESULTS Twelve hearing aid users and six significant others consented to take part. Eight hearing aid users were randomised: four to the intervention group; and four to treatment-as-usual only. Four significant others participated alongside the randomised participants. Recruitment to the study was very low and centres only screened 466 hearing aid users over the 15-month recruitment period, compared with the approximately 3500 anticipated. Only one ACE group and one control group were formed. ACE could be delivered and appeared acceptable to participants. We were unable to robustly assess attrition and attendance rates due to the low sample size. CONCLUSIONS While ACE appeared acceptable to hearing aid users and feasible to deliver, it was not feasible to identify and recruit participants struggling with their hearing aids at the 3-month posthearing aid fitting point. TRIAL REGISTRATION NUMBER ISRCTN28090877.
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Affiliation(s)
- Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Christina Maynard
- Leeds Institute of Cardiovascular & Metabolic Medicine, Univerity of Leeds, Leeds, UK
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rob Gardner
- Audiology Department, Bradford Royal Infirmary, Bradford, UK
| | - Kate Iley
- Audiology Department, York Teaching Hospital NHS Foundation Trust, York, UK
| | | | - Nicholas J Thyer
- Leeds Institute of Cardiovascular & Metabolic Medicine, Univerity of Leeds, Leeds, UK
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Daniels N, Gillen P, Casson K. Researcher practitioner engagement in health research: The development of a new concept. Res Nurs Health 2021; 44:534-547. [PMID: 33774826 DOI: 10.1002/nur.22128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Abstract
The engagement of frontline practitioners in the production of research-derived knowledge is often advocated. Doing so can address perceived gaps between what is known from research and what happens in clinical practice. Engagement practices span a continuum, from co-production approaches underpinned by principles of equality and power sharing to those which can minimalize practitioners' contributions to the knowledge production process. We observed a conceptual gap in published healthcare literature that labels or defines practitioners' meaningful contribution to the research process. We, therefore, aimed to develop the concept of "Researcher Practitioner Engagement" in the context of academically initiated healthcare research in the professions of nursing, midwifery, occupational therapy, physiotherapy, and speech and language therapy. Guided by Schwartz-Barcott et al.'s hybrid model of concept development, published examples were analyzed to establish the attributes, antecedents, and consequences of this type of engagement. Academic researchers (n = 17) and frontline practitioners (n = 8) with relevant experience took part in online focus groups to confirm, eliminate, or elaborate on these proposed concept components. Combined analysis of theoretical and focus group data showed that the essence of this form of engagement is that practitioners' clinical knowledge is valued from a study's formative stages. The practitioner's clinical perspectives inform problem-solving and decision-making in study activities and enhance the professional and practice relevance of a study. The conceptual model produced from the study findings forms a basis to guide engagement practices, future concept testing, and empirical evaluation of engagement practices.
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Affiliation(s)
- Nicola Daniels
- Institute of Nursing and Health Research, School of Nursing, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Patricia Gillen
- Institute of Nursing and Health Research, School of Nursing, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK.,Southern Health and Social Care Trust, Rosedale, Gilford, UK
| | - Karen Casson
- Institute of Nursing and Health Research, School of Nursing, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
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Shropshire MD, Stapleton SJ, Dyck MJ. Barriers and Insights in Participant Recruitment in Assisted Living Facilities. Nurs Sci Q 2020; 33:116-121. [PMID: 32180513 DOI: 10.1177/0894318419898159] [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
An estimated 1.2 million older adults nationwide currently reside in assisted/supportive living facilities, and research is required to continue to identify best outcomes in for their care. However, challenges exist. The aim of this paper is to address barriers and provide insights related to participant recruitment in assisted and supportive living facilities. Identified barriers included unproductive communication with reception area staff, a perceived lack of interest in research activity, and the inability of Director of Nursing (DON) to provide authorization for research activities. Recruitment insights included productive encounters with gatekeepers, establishing trust with executive administration and healthcare personnel, and research team persistence.
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Affiliation(s)
| | | | - Mary J Dyck
- Mennonite College of Nursing at Illinois State University, Normal, IL, USA
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11
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Rabiei L, Eslami AA, Abbasi M, Afzali SM, Hosseini SM, Masoudi R. Evaluating the Effect of Family-Centered Intervention Program on Care Burden and Self-Efficacy of Hemodialysis Patient Caregivers Based on Social Cognitive Theory: A Randomized Clinical Trial Study. Korean J Fam Med 2020; 41:84-90. [PMID: 31958941 PMCID: PMC7093670 DOI: 10.4082/kjfm.18.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/14/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Caregivers of hemodialysis patients spend a large amount of time providing care to these patients while tolerating fatigue and stress. This study evaluated a family-centered empowerment program on the care burden and self-efficacy of hemodialysis patient caregivers based on social cognitive theory. METHODS In this randomized clinical trial, 70 family caregivers of hemodialysis patients in Isfahan, Iran, were selected and randomly allocated to intervention and control groups, in 2015-2016. Two questionnaires were used to collect the family caregivers' characteristics, care burden, and self-efficacy, and patients' negative and positive outcomes expectancies. Data were analyzed using SPSS before, immediately after, and 2 months after the intervention. RESULTS There was no significant difference in the mean scores of care burden, positive outcomes expectancies, negative outcomes expectancies, and self-efficacy between the two groups before the intervention. However, there were significant differences in the post-test and follow-up data analyses (P<0.05). CONCLUSION Given the degenerative nature of chronic kidney disease, it can be considered as a source of long-term and chronic stress for caregivers. Therefore, by implementing an empowerment program, caregiving behaviors can be improved, positive outcomes expectancies can be increased, and negative outcomes expectancies can be reduced.
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Affiliation(s)
- Leili Rabiei
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ahmad Ali Eslami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Abbasi
- Department of Nursing, School of Nursing and Midwifery, Qom Univers ity of Medical Sciences, Qom, Iran
| | - Seyed Mohammad Afzali
- Department of Nursing, School of Nursing and Midwifery, Shahrekord Univers ity of Medical Sciences, Shahrekord, Iran
| | - Seyed Masih Hosseini
- Department of Histology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Reza Masoudi
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Kaiser KS, McGuire DB, Keay TJ, Haisfield-Wolfe ME. Methodological challenges in conducting instrumentation research in non-communicative palliative care patients. Appl Nurs Res 2019; 51:151199. [PMID: 31759841 DOI: 10.1016/j.apnr.2019.151199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 10/18/2019] [Indexed: 01/09/2023]
Abstract
Well-designed, rigorously implemented instrumentation studies are essential to develop valid, reliable pain assessment tools in non-communicative (non-self-reporting) palliative care patients. When conducting a pain instrumentation study, a research team identified methodologic challenges surrounding informed consent, eligibility criteria, acute pain operational definitions, patient recruitment, missing data, and study-related training during a run-in phase at the beginning of the project and during the conduct of the study. The team dealt with these challenges through identifying root causes, implementing remedial measures, and collecting data to demonstrate improvement or resolution. Effective strategies included obtaining Institutional Review Board (IRB) approval for a waiver of informed consent, modifying eligibility criteria, ensuring that operational definitions and study procedures were consistent with clinical practice, decreasing time from screening to data collection to improve recruitment, increasing study nurse staffing by re-budgeting grant funds, focusing time and resources on high accruing clinical units, revising processes to minimize missing data, and developing detailed training for users of the instrument. With these multi-pronged solutions, the team exceeded the patient accrual target by 25% within the funding period and reduced missing data. While pain instrumentation studies in non-communicative patients have similar challenges to other palliative care studies, some of the solutions may be unique and several are applicable to other palliative care studies, particularly instrumentation research. The team's experience may also be useful for funders and IRBs.
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Affiliation(s)
- Karen Snow Kaiser
- Corporate Education, University of Maryland Capital Region Health, 3001 Hospital Drive, Cheverly, MD 20785-1189, United States of America.
| | - Deborah B McGuire
- Professor Emeritus, Virginia Commonwealth University School of Nursing, 1100 East Leigh St., Richmond, VA 23298-0567, United States of America
| | - Timothy J Keay
- Formerly: Department of Family and Community Medicine, Palliative Care, University of Maryland School of Medicine Baltimore, MD 21201, United States of America
| | - Mary Ellen Haisfield-Wolfe
- Formerly: University of Maryland Baltimore School of Nursing, Baltimore, MD 21201, United States of America
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13
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Edwards Z, Bennett MI, Petty D, Blenkinsopp A. Evaluating recruitment methods of patients with advanced cancer: a pragmatic opportunistic comparison. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:536-544. [PMID: 31287212 DOI: 10.1111/ijpp.12562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Recruitment of patients with advanced cancer into studies is challenging.
Objective
To evaluate recruitment methods in a study of pharmacist-led cancer pain medicine consultations and produce recommendations for future studies.
Method
Two methods of recruitment were employed: (1) community-based (general practitioner computer search, identification by general practitioner, community pharmacist or district nurse and hospital outpatient list search) and (2) hospice-based (in and outpatient list search). Patients identified in method 1 were invited by post and in method 2 were invited face-to-face. Information was designed in collaboration with patients and carers.
Results
A total of 128 patients were identified (85 from the community and 43 from the hospice), and 47 met the inclusion criteria. Twenty-three agreed to take part and 19 completed the study, 17 of whom were already under specialist palliative care. Recruitment rates were 7% for community-based methods and 40% for hospice. The recruitment methods differed in intensity of resource use. Recruitment via letter and a lack of engagement by healthcare professionals were found to be barriers. Facilitators included the researcher having personal involvement in recruitment.
Conclusion
The overall recruitment rate was in line with other studies for this patient cohort. Attempts to identify and engage patients through community-based postal contact were less effective than where personal contact with patients was both possible and occurred. Methods were less successful at recruiting patients who were not already engaged with hospice services.
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Affiliation(s)
- Zoe Edwards
- University of Bradford, Bradford, West Yorkshire, UK
| | | | - Duncan Petty
- University of Bradford, Bradford, West Yorkshire, UK
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14
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Snowden A, Young J. A screening tool for predicting gatekeeping behaviour. Nurs Open 2017; 4:187-199. [PMID: 29085645 PMCID: PMC5653390 DOI: 10.1002/nop2.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Abstract
AIM To develop a typology and screening tool for gatekeeping behaviours by nurses responsible for recruitment in palliative care research. DESIGN Concurrent analysis. METHOD Two focus groups were conducted in 2015 with nine qualified hospice community nurses involved in recruitment to a trial in palliative care. The literature was searched for research into gatekeeping from 2000-2016. All narrative examples of gatekeeping activity were coded using gerunds. Common codes were then grouped and interpreted as a social process. RESULTS Gatekeeping is normal and should be expected. A continuum typology emerged, ranging from unintentional to active disengagement. Justification ranged from forgetting to deliberately not mentioning the study for fear of burdening patients. Viewing gatekeeping as a continuum allowed for the creation of a screening tool designed to collaboratively discuss and hence mitigate specific types of gatekeeping behaviour before they occur. This is a unique international contribution to this persistent issue.
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Affiliation(s)
| | - Jenny Young
- Edinburgh Napier UniversityEdinburghEH11 4BNUK
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15
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Matikainen MA. Promoting the legitimacy and agency of new graduate nurses' participation in nursing research. Contemp Nurse 2017; 53:293-301. [PMID: 28583019 DOI: 10.1080/10376178.2017.1338524] [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: 10/19/2022]
Abstract
AIM This paper explores the legitimacy and agency of new graduate mental health nurses to participate in research activities as a regular part of their professional nursing role. BACKGROUND There is a wealth of literature describing personal and organisational factors that act as barriers to nurses' engagement in research and overcoming these barriers remains a challenge for health organisations. Some new graduate nurses are well positioned to contribute to research and yet the literature has given little attention to this specific cohort. RESULTS This paper will show how facilitating new graduates' participation in research benefits the new graduate and the health service. CONCLUSION New graduates learn research skills from experienced researchers and this ensures a sustainable future workforce of researchers. Employers who support staff to pursue professional challenges such as research are more likely to generate organisational commitment and loyalty amongst staff.
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Affiliation(s)
- Mary Ann Matikainen
- a Mental Health Service, Hunter New England Local Health District , New South Wales , Australia
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16
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Understanding family assessment in the Australian context; what are adult oncology nursing practices? Collegian 2017. [DOI: 10.1016/j.colegn.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kars MC, van Thiel GJ, van der Graaf R, Moors M, de Graeff A, van Delden JJ. A systematic review of reasons for gatekeeping in palliative care research. Palliat Med 2016; 30:533-48. [PMID: 26577927 DOI: 10.1177/0269216315616759] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND When healthcare professionals or other involved parties prevent eligible patients from entering a trial as a research subject, they are gatekeeping. This phenomenon is a persistent problem in palliative care research and thought to be responsible for the failure of many studies. AIM To identify potential gatekeepers and explore their reasons for gatekeeping in palliative care research. DESIGN A 'Review of Reasons' based on the systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach and a thematic synthesis. DATA SOURCE PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycINFO from 2000 to May 20 2015 were searched. Studies in children (aged <18 years) and patients with dementia were excluded. RESULTS Thirty papers on gatekeeping in palliative care research were included. Five groups of potential gatekeepers were identified: healthcare professionals, research ethics committees, management, relatives and researchers. The fear of burdening vulnerable patients was the most reported reason for gatekeeping. Other reasons included 'difficulty with disclosure of health status', 'fear of burdening the patient's relatives', 'doubts about the importance or quality of the study', 'reticent attitude towards research and (research) expertise' and 'logistics'. In hospice and homecare settings, the pursuit of comfort care may trigger a protective attitude. Gatekeeping is also rooted in a (perceived) lack of skills to recruit patients with advanced illness. CONCLUSION Gatekeeping is motivated by the general assumption of vulnerability of patients, coupled with an emphasis on the duty to protect patients. Research is easily perceived as a threat to patient well-being, and the benefits appear to be overlooked. The patients' perspective concerning study participation is needed to gain a full understanding and to address gatekeeping in palliative care research.
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Affiliation(s)
- Marijke C Kars
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine Jmw van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Moors
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes Jm van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Coyne E, Grafton E, Reid A. Strategies to successfully recruit and engage clinical nurses as participants in qualitative clinical research. Contemp Nurse 2016; 52:669-676. [PMID: 27108654 DOI: 10.1080/10376178.2016.1181979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research conducted in the clinical area promotes the delivery of evidence-based patient care. Involving nurses as participants in research is considered essential to link patient care with evidence-based interventions. However recruitment is influenced by nurses' competing demands and understanding engagement strategies may assist future research. AIM This reflective analysis aimed to understand influencing factors and strategies that support successful recruitment nurses in clinical research. METHOD A reflective analysis of research notes and focus group data from research with oncology nurses was completed. RESULTS This research identified that gaining support from key staff, understanding work constraints and developing a rapport with nurses is important. Establishing clear relevance and benefits of the research and being flexible with research requirements enabled nurses to participate in the research. CONCLUSION Clear information and a willingness to accommodate the demands and dynamic nature of the environment, ensures ongoing support and engagement of nurses in the clinical setting as participants in research.
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Affiliation(s)
- Elisabeth Coyne
- a School of Nursing and Midwifery , Griffith University , Logan Campus, University Drive, Meadowbrook , QLD 4131 , Australia.,b Menzies Health Institute Queensland , Gold Coast Campus, Griffith University , QLD 4222 , Australia
| | - Eileen Grafton
- a School of Nursing and Midwifery , Griffith University , Logan Campus, University Drive, Meadowbrook , QLD 4131 , Australia
| | - Alayne Reid
- a School of Nursing and Midwifery , Griffith University , Logan Campus, University Drive, Meadowbrook , QLD 4131 , Australia
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Whitehead PB, Clark RC. Addressing the challenges of conducting research with end-of-life populations in the acute care setting. Appl Nurs Res 2016; 30:12-5. [PMID: 27091246 DOI: 10.1016/j.apnr.2015.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
End-of-life (EOL) conversations are difficult for patients, families, and nurses. The purpose of this article is to describe the challenges encountered and strategies implemented during a research study designed to elicit information about the congruence among patients' stated preferences at EOL with perceptions of their caregivers and nurses using the Preferences About Dying and Death (PADD) instrument in an acute care setting. With the proper study inclusion criteria, education and support from more confident, experienced colleagues, nurses can be coached to identify appropriate participants for EOL research. Researchers should plan regularly scheduled debriefing sessions with interviewers to provide emotional support and encouragement to minimize distress. A scripted approach to introduce EOL research topics can ease clinicians' discomfort while allowing patients the opportunity to have open, honest dialogues about their care preferences. By proactively implementing strategies, researchers can enhance the integration of EOL research into the acute care setting.
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Affiliation(s)
- Phyllis B Whitehead
- Carilion Roanoke Memorial Hospital, Roanoke, VA, USA; Virginia Tech Carilion, School of Medicine, Roanoke, VA, USA.
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20
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Johnston B, Pringle J, Buchanan D. Operationalizing reflexivity to improve the rigor of palliative care research. Appl Nurs Res 2015; 31:e1-5. [PMID: 26620579 DOI: 10.1016/j.apnr.2015.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research.
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Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, The University of Nottingham, Queen's Medical Centre, Nottingham NG7 2HA.
| | - Jan Pringle
- University of Dundee and University of Nottingham, School of Nursing and Midwifery, Airlie Place, Dundee
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21
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Blanner Kristiansen C, Juel A, Vinther Hansen M, Hansen AM, Kilian R, Hjorth P. Promoting physical health in severe mental illness: patient and staff perspective. Acta Psychiatr Scand 2015; 132:470-8. [PMID: 26696384 DOI: 10.1111/acps.12520] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore physical health problems and their causes in patients with severe mental illness, as well as possibilities for prevention and treatment from the patients' and staff's perspectives. METHOD We conducted six focus groups with patients and staff separately, from three out-patient clinics treating patients with schizophrenia or substance-use disorder comorbid to another psychiatric disorder. Focus groups were audio-recorded, transcribed verbatim and analysed using a template approach. RESULTS Paramount physical health problems are weight issues, cardiovascular diseases and poor physical shape. Main causes are lifestyle, the mental disorder and organisational issues. Patients and staff expressed similar opinions regarding physical health problems and their causes. Possibilities for prevention and treatment includes a case manager and binding communities with like-minded, as well as management support and implementation of physical health into daily psychiatric practice. Although patients and staff suggested different possibilities for prevention and treatment, they support one strategy: less fragmentation of the treatment system and cooperation between psychiatric and somatic healthcare. CONCLUSION To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. Management support is needed to change daily practice and implement routines regarding physical health.
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Affiliation(s)
| | - A Juel
- Department of Organic Mental Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Denmark
| | | | - A M Hansen
- Clinic for Young People with Schizophrenia, Regional Psychiatry West, Herning, Denmark
| | - R Kilian
- Department of Psychiatry II, University of Ulm, Günzburg, Germany
| | - P Hjorth
- Mental Health Centre, Psychiatric Hospital, Randers, Denmark
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22
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Munk-Jørgensen P, Blanner Kristiansen C, Uwawke R, Larsen JI, Okkels N, Christiansen B, Hjorth P. The gap between available knowledge and its use in clinical psychiatry. Acta Psychiatr Scand 2015; 132:441-50. [PMID: 26463889 DOI: 10.1111/acps.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The time span between knowledge becoming available and its integration into daily clinical routine is lengthy. This phenomenon is explored in this study. METHOD We used the outcomes of our activities for investigating and strengthening the research-based activities to improve physical health in the routines of clinical psychiatric wards as examples for our analyses. RESULTS The time span between new knowledge becoming available and its implementation into general clinical treatment is very long. However, a shortening of this time span is seen through active leadership backup and clinical research experience among psychiatrists and staff in the wards. In particular, the involvement of medical students interested in clinical research activities seems to have a positive impact. CONCLUSION Academia needs to be re-implemented into clinical psychiatry. Staff with research experience is needed in all professions to increase evidence-based practice. Leaders must take responsibility for implementing new knowledge into the routines of the department and must support staff in these activities on a daily basis.
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Affiliation(s)
- P Munk-Jørgensen
- Aarhus University Hospital, Risskov, Denmark.,Department of Psychiatry, Odense - University Function, University of Southern Denmark, Odense, Denmark
| | | | - R Uwawke
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - J I Larsen
- Psychiatric University Hospital, Aalborg, Denmark
| | - N Okkels
- Aarhus University Hospital, Risskov, Denmark
| | | | - P Hjorth
- Regional Psychiatry, Randers, Denmark
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Abernethy AP, Capell WH, Aziz NM, Ritchie C, Prince-Paul M, Bennett RE, Kutner JS. Ethical conduct of palliative care research: enhancing communication between investigators and institutional review boards. J Pain Symptom Manage 2014; 48:1211-21. [PMID: 24879998 PMCID: PMC4247357 DOI: 10.1016/j.jpainsymman.2014.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/21/2014] [Accepted: 05/06/2014] [Indexed: 11/22/2022]
Abstract
Palliative care has faced moral and ethical challenges when conducting research involving human subjects. There are currently no resources to guide institutional review boards (IRBs) in applying standard ethical principles and terms-in a specific way-to palliative care research. Using as a case study a recently completed multisite palliative care clinical trial, this article provides guidance and recommendations for both IRBs and palliative care investigators to facilitate communication and attain the goal of conducting ethical palliative care research and protecting study participants while advancing the science. Beyond identifying current challenges faced by palliative care researchers and IRBs reviewing palliative care research, this article suggests steps that the palliative care research community can take to establish a scientifically sound, stable, productive, and well-functioning relationship between palliative care investigators and the ethical bodies that oversee their work.
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Affiliation(s)
- Amy P Abernethy
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Warren H Capell
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Noreen M Aziz
- Division of Extramural Activities, National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Ritchie
- University of California at San Francisco, San Francisco, California, USA
| | - Maryjo Prince-Paul
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Jean S Kutner
- University of Colorado School of Medicine, Aurora, Colorado, USA.
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Rainsford S, Bullen T, Rosenberg J. Challenges of recruiting hospice inpatients with advanced cancer to research: Reflections on a delirium screening study. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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