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Bayram E, Rigler N, Wang KT, Tsai A, Flatt JD. Sexual Orientation, Gender Identity, and Experiences During, Awareness of, and Attitudes Toward Research for People With Parkinson Disease. Neurol Clin Pract 2024; 14:e200304. [PMID: 38808025 PMCID: PMC11129331 DOI: 10.1212/cpj.0000000000200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/06/2024] [Indexed: 05/30/2024]
Abstract
Background and Objectives Presentation, progression, and treatment of Parkinson disease (PD) can differ based on sex and gender. However, knowledge on PD is limited by the characteristics of research participants, and most of the participants are men. In this study, we aimed to identify the attitudes toward and barriers to research participation for people with PD (PwP) based on their sexual orientation and gender identity. Methods Data were obtained from the Fox Insight on March 16, 2023, for PwP who completed the Attitudes and Beliefs Regarding Research and Genetic Testing for PD. Responses were compared between sexual and gender minorities (SGM) (n = 136), cisgender heterosexual women (n = 1,479), and cisgender heterosexual men (n = 1,445). Associations between age, socioeconomic variables, and the responses that differed between the groups were assessed with linear models. Results More than 68% of the participants were willing to participate in research; only 43.7% heard about research opportunities, and 52.3% knew where to find a study. Approximately 86.8% of the participants reported hearing about a study from their doctor would make them more likely to participate. A higher percentage of SGM were concerned about transportation and researchers not understanding or respecting their beliefs; a higher percentage of cisgender heterosexual women were concerned about transportation, data privacy, and their family's reaction to genetic results; and a higher percentage of cisgender heterosexual men were concerned about time required for research activities and complex forms. Age and socioeconomic variables were significantly associated with approach toward research that differed between the groups. Discussion PwP are willing to participate in research, and health care providers can facilitate their participation. Barriers to research participation related to sexual and gender identity exist and must be addressed to increase our understanding of PD in underrepresented populations.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center (EB, KTW, AT), Department of Neurosciences; School of Medicine (NR), University of California, San Diego; and Department of Environmental and Occupational Health (JDF), School of Public Health, University of Nevada, Las Vegas
| | - Nicole Rigler
- Parkinson and Other Movement Disorders Center (EB, KTW, AT), Department of Neurosciences; School of Medicine (NR), University of California, San Diego; and Department of Environmental and Occupational Health (JDF), School of Public Health, University of Nevada, Las Vegas
| | - Kevin T Wang
- Parkinson and Other Movement Disorders Center (EB, KTW, AT), Department of Neurosciences; School of Medicine (NR), University of California, San Diego; and Department of Environmental and Occupational Health (JDF), School of Public Health, University of Nevada, Las Vegas
| | - Andrew Tsai
- Parkinson and Other Movement Disorders Center (EB, KTW, AT), Department of Neurosciences; School of Medicine (NR), University of California, San Diego; and Department of Environmental and Occupational Health (JDF), School of Public Health, University of Nevada, Las Vegas
| | - Jason D Flatt
- Parkinson and Other Movement Disorders Center (EB, KTW, AT), Department of Neurosciences; School of Medicine (NR), University of California, San Diego; and Department of Environmental and Occupational Health (JDF), School of Public Health, University of Nevada, Las Vegas
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Ison JM, Jackson JD, Hemley H, Willis A, Siddiqi B, Macklin EA, Ulysse C, Fitts MS, Pham TTH, Afshari M, Agarwal P, Aminoff M, Bissonnette S, Fullard M, Khan TS, Larson DN, Wielinski C, Sanchez AV. Fostering Inclusivity in Research Engagement for Underrepresented Populations in Parkinson's Disease: The FIRE-UP PD study. Contemp Clin Trials 2024; 144:107619. [PMID: 38971301 DOI: 10.1016/j.cct.2024.107619] [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: 02/23/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Members of vulnerable populations are underrepresented in Parkinson's disease (PD) research. A complex web of research barriers perpetuates this gap. Community-based research methods are one approach to addressing this issue. The present PD study was designed to examine the effectiveness of community-based interventions to overcome barriers and increase research participation among underrepresented groups (URGs). METHODS Eight study sites across the US were selected and paired based on proposed interventions with specific URGs. Surveys assessed knowledge and attitudes toward PD research. Finally, researchers examined whether the present study affected recruitment to Fox Insight, an online PD research study also recruiting at each site. RESULTS In total, 474 participants were recruited. At post-intervention for the FIRE-UP PD Study, recruitment increased significantly in intervention compared to control sites among Black and African American non-Hispanic/Latino populations (p = 0.003), White Hispanic/Latino (p = 0.003) populations, and Not Listed Hispanic/Latino populations (p < 0.001) as well as those with an educational attainment of a high school diploma/General Education Diploma (GED) (p = 0.009), and an income <$20,000 (p = 0.005) or between $20,000-$34,999 (p < 0.001). Study surveys measuring changes in awareness and attitudes toward PD research had mixed results. In Fox Insight, 181 participants were passively recruited with a shift toward more diverse participant demographics. CONCLUSION Research participation demographics reflective of the general population are critical to PD investigation and treatment. The FIRE-UP PD Study showed the effectiveness of localized community engagement strategies in increasing URG recruitment to PD research. Therefore, further PD research employing community-based methods to improve diverse participant recruitment is needed.
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Affiliation(s)
- Juliana M Ison
- University of California, Gevirtz Graduate School of Education, Isla Vista, Santa Barbara, CA 93106, USA
| | - Jonathan D Jackson
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Helen Hemley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Allison Willis
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Bernadette Siddiqi
- The Michael J. Fox Foundation, 111 W. 33rd St, New York City, NY 10120, USA
| | - Eric A Macklin
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Christine Ulysse
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Michael S Fitts
- University of Alabama at Birmingham (UAB Libraries), 1700 University Blvd, Birmingham, AL 35233, USA
| | - Tiffany T-H Pham
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Mitra Afshari
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
| | - Pinky Agarwal
- Evergreen Health Care, 12040 NE 128th St, Kirkland, WA 98034, USA
| | - Michael Aminoff
- University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA
| | - Stephanie Bissonnette
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298, USA
| | - Michelle Fullard
- University of Colorado Denver, 1201 Larimer St, Denver, CO 80204, USA
| | - Tarannum S Khan
- Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | | | - Catherine Wielinski
- Park Nicollet Struthers Parkinson's Center, 6701 Country Club Dr, Minneapolis, MN 55427, USA
| | - Angie V Sanchez
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; University of Louisiana at Lafayette, 104 E University Ave, Lafayette, LA 70504, USA.
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Mestre TA, Stebbins GT, Stephenson D, Dexter D, Lee KK, Xiao Y, Dam T, Kopil CM, Simuni T. Patient-centered development of clinical outcome assessments in early Parkinson disease: key priorities and advances. NPJ Parkinsons Dis 2024; 10:101. [PMID: 38744872 PMCID: PMC11094181 DOI: 10.1038/s41531-024-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Tiago A Mestre
- Ottawa Hospital Research Institute; University of Ottawa Brain and Mind Research Institute; Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Ottawa, Ottawa, ON, Canada.
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Yuge Xiao
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Tien Dam
- Neumora Therapeutics, Cambridge, MA, USA
| | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sanchez AV, Ison JM, Hemley H, Jackson JD. Diversifying the research landscape: Assessing barriers to research for underrepresented populations in an online study of Parkinson's disease. J Clin Transl Sci 2024; 8:e34. [PMID: 38384928 PMCID: PMC10879993 DOI: 10.1017/cts.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/26/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
Despite federal regulations mandating the inclusion of underrepresented groups in research, recruiting diverse participants remains challenging. Identifying and implementing solutions to recruitment barriers in real time might increase the participation of underrepresented groups. Hence, the present study created a comprehensive dashboard of barriers to research participation. Barriers to participation were recorded in real time for prospective participants. Overall, 230 prospective participants expressed interest in the study but were unable to join due to one or more barriers. Awareness of the most common obstacles to research in real time will give researchers valuable data to meaningfully modify recruitment methods.
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Affiliation(s)
- Angie V. Sanchez
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Jonathan D. Jackson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Feldmann LK, Roudini J, Kühn AA, Habets JGV. Improving naturalistic neuroscience with patient engagement strategies. Front Hum Neurosci 2024; 17:1325154. [PMID: 38259336 PMCID: PMC10800538 DOI: 10.3389/fnhum.2023.1325154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The clinical implementation of chronic electrophysiology-driven adaptive deep brain stimulation (DBS) algorithms in movement disorders requires reliable representation of motor and non-motor symptoms in electrophysiological biomarkers, throughout normal life (naturalistic). To achieve this, there is the need for high-resolution and -quality chronic objective and subjective symptom monitoring in parallel to biomarker recordings. To realize these recordings, an active participation and engagement of the investigated patients is necessary. To date, there has been little research into patient engagement strategies for DBS patients or chronic electrophysiological recordings. Concepts and results We here present our concept and the first results of a patient engagement strategy for a chronic DBS study. After discussing the current state of literature, we present objectives, methodology and consequences of the patient engagement regarding study design, data acquisition, and study infrastructure. Nine patients with Parkinson's disease and their caregivers participated in the meeting, and their input led to changes to our study design. Especially, the patient input helped us designing study-set-up meetings and support structures. Conclusion We believe that patient engagement increases compliance and study motivation through scientific empowerment of patients. While considering patient opinion on sensors or questionnaire questions may lead to more precise and reliable data acquisition, there was also a high demand for study support and engagement structures. Hence, we recommend the implementation of patient engagement in planning of chronic studies with complex designs, long recording durations or high demand for individual active study participation.
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Affiliation(s)
- Lucia K. Feldmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Juliet Roudini
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité, Berlin, Germany
- Patient and Stakeholder Engagement, Cluster of Excellence, NeuroCure, Berlin, Germany
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charité University Medicine, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany
- DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany
| | - Jeroen G. V. Habets
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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McKee KE, Gilbert RM, Spigle WA, Tilley BC, Corcos DM. Inclusion of Non-English-Speaking Participants in Studies of Parkinson's Disease: A Call to Action. Mov Disord 2022; 37:1990-1995. [PMID: 35929651 PMCID: PMC9588513 DOI: 10.1002/mds.29179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kathleen E McKee
- Neurosciences Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | | | - Barbara C Tilley
- Biostatistics and Data Science, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Daniel M Corcos
- Departments of Physical Therapy & Human Movement Sciences and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
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Fleisher JE, Hess SP, Klostermann EC, Lee J, Myrick E, Mitchem D, Niemet C, Woo K, Sennott BJ, Sanghvi M, Witek N, Beck JC, Wilkinson JR, Ouyang B, Hall DA, Chodosh J. IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease. Parkinsonism Relat Disord 2022; 102:68-76. [PMID: 35963046 PMCID: PMC9578443 DOI: 10.1016/j.parkreldis.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
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Affiliation(s)
- Jori E. Fleisher
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Rush Graduate College, Rush University Medical Center, 600 South Paulina Street, Suite 438, Chicago, IL, 60612, USA,Corresponding author. Department of Neurological Sciences, Division of Movement Disorders, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA. (J.E. Fleisher)
| | - Serena P. Hess
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Ellen C. Klostermann
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Claire Niemet
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Loyola University Chicago College of Arts and Sciences, 1032 West Sheridan Road, Chicago, IL, 60660, USA.
| | - Brianna J. Sennott
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA
| | - Maya Sanghvi
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie Witek
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - James C. Beck
- Parkinson’s Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA
| | - Jayne R. Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA,Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA.
| | - Deborah A. Hall
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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